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Tryptase is the most abundant endopeptidase released by mast cells degranulation, involved in many pro and anti-inflammatory processes. Normal serum tryptase range is 0-11.4 μg/L. Tryptase is a useful diagnostic tool for anaphylaxis, systemic mastocytosis (SM) and mast cell activation syndrome (MCAS), where specific threshold values must be used. SM diagnosis criteria include evidence of dense mast cell infiltrate either in the bone marrow or the affected organ (such as skin), presence of KIT D816V mutation and elevated serum tryptase level (>20 μg/L). In SM, tryptase level is correlated with the burden of mast cells in bone marrow. MCAS should be considered in case of severe and recurrent typical clinical signs of systemic mast cell activation involving at least two organs, associated with an increase in serum tryptase level of 20% + 2 μg/L from the individual's baseline. Anaphylaxis is the most severe among hypersensitivity reactions. A clonal mast cell disorder is a central question in anaphylaxis and appropriate explorations should be conducted in these patients. Triggers for anaphylactic reactions vary significantly in the general population and in patients with MS or MCAS. Finally, physicians must be aware of the many pathological and physiological situations that affect tryptase levels., (Copyright © 2020. Published by Elsevier Masson SAS.)

Introduction: Since 2013, at the French society of ophthalmology (FSO) meetings, two simulators for intraocular surgeries have been available. The goal of this study was to assess the satisfaction of the participants in these organized training sessions., Materials and Methods: A questionnaire was mailed to participants in the FSO sessions as well as those carried out during the annual congress. This questionnaire collected data on the participants and the practical modalities of the sessions, and assessed participants' feelings and satisfaction with these sessions., Results: The participants in the SFO sessions were young members of the SFO (31.8±12.3 years). 53.8 % were in training, looking to improve a problematic surgical step (capsulorhexis in 51.5 %). They spent nearly 5hours on simulators (4.8hours) and were alone on a simulator 50 % of the time. The sessions held during the annual congress were used by older physicians (41.9±26.4 years) already in practice (66.6 %). The goal of such training was curiosity in a third of the cases (to try the simulators). The majority spent less than an hour on the devices and were at least two participants per machine. Despite these differences, participants cited a role for their surgical learning curve and recommended such training to their colleagues., Conclusions: The participants' enthusiasm for this new training technique is highlighted by the results of this study., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Objectives: The objective of this study was to validate a continuing medical education e-learning tool., Methods: The CME MMC was for all health professionals maternity Burgundy and concerned regional morbidity and mortality conferences. It was divided into steps: a pre-test for an assessment of initial knowledge, an access to the recommendations of each RMM and a post-test to assess the progress of participants. A satisfaction questionnaire was proposed after the test. The primary endpoint was the comparison of the post-test scores than the pre-test., Results: CME MMC was opened 3 months and recorded 156 participants among 598 health professionals in Burgundy, a rate 2.4 times higher than the average participation rate at MMC the past two years. A statistically significant increase was demonstrated individually by comparing the post-test scores than the pre-test (P<0.00001). The increase was significantly higher for midwives and professionals absents at the RMM. Finally, 96.2% of participants have been satisfied by this formation., Conclusion: This prospective multicenter study validates our tool. CME MMC is accessible, without geographic or time restrictions, not expensive, and efficient because it proves that it can update our knowledge in obstetrics and perinatology., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: Annual screening for lung cancer using low-dose CT-scans is associated with decreased mortality. A survey conducted in Rhône-Alpes area in France found that clinicians need education and information on this topic. Script concordance tests (SCT) are a tool for assessing clinical reasoning in situations of uncertainty. They have not previously been used in France in the context of continuing medical education., Method: We created a questionnaire with 5 multiple-choice questions (MCQ) and two SCT scenarios. The questionnaire was sent to all clinicians and residents who are members of French-Speaking Respiratory Society or the French Young Pulmonologist Association., Results: One hundred and ninety answers were analyzed. Seventy percent stated that decreasing mortality was the best criterion for assessing the effectiveness of a cancer screening policy, and 75% that low-dose CT scan was the best test to achieve this in lung cancer screening. Forty-five percent knew the eligibility criteria of the population, and 62% that low-dose CT scan should be performed annually. Participation in tumor boards and certification in oncology were significantly associated with a better score at MCQ and SCT. SCT and MCQ scores were significantly correlated (Spearman's Rho 0.339; P<0.0001)., Conclusion: SCT are feasible by electronic survey and seem relevant. Improving knowledge of clinicians on lung cancer screening is still critical., (Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Electronic fetal monitoring during labor is the most commonly used method to evaluate the fetal status, but it remains exposed to some criticism. By comparison with intermittent auscultation and in the light of the results of the great studies in the last 30 years, it may be accused its failure to improve the neonatal outcome and its responsibility in the increase on operative deliveries. Actually, the electronic fetal monitoring is a tool whose effectiveness is linked to the accuracy of the analysis developed by the clinician. Studies on assessment of the tracing interpretation indicate that there is always a lack of quality, which may be improved through training programs. It also reveals the benefit of the fetal blood sampling to reduce operative deliveries and the generalization of this method, in addition to electronic fetal monitoring, is recommended by referral agencies. More generally, the continuous monitoring is only a part of the patient safety strategy in the labour ward and we are currently observing, in some European countries and in the United States, the development of training programs concerning the management of the adverse outcomes in obstetrics. The good performances related to the quality of care are demonstrated by the findings of the studies performed in the centers that have implemented an active training policy. In France, the professionals directly involved in the field of the perinatology should benefit from such educational programs that could be organized within the care networks under the authority of referral agencies., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

The Union européenne des médecins spécialistes (UEMS) has a mandate to lead the quality of care in Europe and harmonise the qualifications of specialists doctors. In 2000, UEMS has set the European Accreditation Council for Continuing Medical Education (EACCME), with the objective to accredit educational events and facilitate the reciprocity of CME credits obtained by attending international medical conferences. In 2010, UEMS has set the European Accreditation Council for Medical Specialist Qualification (EACMSQ). This 2-year pilot project concerns three specialties with the goal to harmonise the competencies' assessment. In 2010, 35 countries are UEMS members, corresponding to 1,5 millions specialists doctors. Each of the 38 medical specialties has a 'section' and a four-members' board. Since 2000, the Europe developed the CPD concepts, and definitions were customised per country and health systems. The Rome group defined the CPD: "Continuing professional development is the educative means of updating, developing and enhancing how doctors apply the knowledge, skills and attitudes required in their working lives. This includes CME, professional and managerial (non-clinical) competencies, and all elements of Good Medical Practice". The learning concepts must be better developed in the health care systems as it has been done in other sectors of activity. Learning is the concept considering that it's no more possible to characterise the learner as a sponge absorbing information. The virtuous cycle of CME is well-known: assess his professional needs; set the needs and objectives; implement an educational plan with the right methods; conduct the actions and get the data; assess the events according to levels (participation, satisfaction, learning, performance, patient's health, population's health). Financing of events usually is shared between payers: state, insurers, industries, doctors but in fine, the public is the major payer. Education must be independent from all influences and recommendations should be set. Countries have mandatory or voluntary CME/CPD systems but it's not a criterium of a better performance. National authorities accredit organisms or events, and that does not make any difference., (Copyright © 2011. Published by Elsevier Masson SAS.)

The Swiss postgraduate training program in general internal medicine is now designed as a competency-based curriculum. In other words, by the end of their training, the residents should demonstrate a set of predefined competences. Many of those competences have to be learnt in outpatient settings. Thus, the primary care physicians have more than ever an important role to play in educating tomorrows doctors. A competency-based model of training requires a regular assessment of the residents. The mini-CEX (mini-Clinical Evaluation eXercise) is the assessment tool proposed by the Swiss institute for postgraduate and continuing education. The mini-CEX is based on the direct observation of the trainees performing a specific task, as well as on the ensuing feedback. This article aims at introducing our colleagues in charge of residents to the mini-CEX, which is a useful tool promoting the culture of feedback in medical education.

Internet, unknown there fifteen years, has become commonly used today to communicate and exchange all types of information. Concerning medical points, this network is full of data and has become indispensable to physicians. The biomedical knowledge base is changing so fast that it is impossible for a doctor to know everything about everything. Specialists are increasingly specialized but must keep aware of developments in medical knowledge and above all must be able to search quickly and effectively in a given time. To stay informed, they have several means of which the most common are reading the press, Continuing Medical Education and now Internet. Unfortunately, the richness of the Web is also its main fault so we must have the knowledges for searching, analyzing, among the flood of documents available if we do not want to be caught by the screen. Internet usage is done by two approaches: the pull: dynamic approach to information retrieval and the push: passive process of receiving documents. Most doctors have not been trained to use this tool although it became their main source of knowledge and research. This article aims to outline the main ways to learn about a specific topic by giving some tips for saving time.

Continuous medical evaluation (CME) is compulsory which aims to ameliorate and guarantee quality of care. This paper describes the experience of our unit during the different stages of evaluation that permit us to obtain our accreditation. Our evaluation dealt with the "amelioration of women's and newborn's care after scheduled caesarean section". A first retrospective study of files of scheduled caesareans allowed to update possible points of improvement, after application of adapted corrective actions, both at the medical and paramedical level. The second study, made after application of these actions, allowed to appreciate the results of our initiative of CME, to update new possible points of improvement, but also to notice certain limits in the achievement of the objectives., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Unlabelled: Serbian oncologists benefited of a short training in French structures as observer between 2003 and 2007. To this day, there has been yet no study on the professional feedback of this kind of training for foreigner doctors. Our aim was to evaluate the satisfaction of the participants and thereafter to analyse their needs., Material and Methods: Survey by auto questionnaires sent to the participants oncologists., Results: On 60 oncologists, 40 answered. On all the oncologists interviewed, 90% thought that the knowledge was easily accessible and is still useful. Sixty per cent said they introduced new protocols; 92.3% wished they could have another training. Compared to their own practise in Serbia, 97% think there is a employee in charge of administrative questions that set the doctors free to do something else., Discussion: To optimise these training's, basic knowledge of French and well-targeted expectations are essential. To improve professional practise of oncologists, the answers go to a best internal communication and the establishment of a politic of education for doctors and the rest of the personal in oncology services.

Background: For several years, the sessions of continuing medical education organized within the framework of the Société française de neurochirurgie have been recorded on the "campus de neurochirurgie" website, accessible in a form called in "videostreaming" which structures the training session., Purpose: Using modern educational methods, how can we transform the scientific productions of our meetings into effective tools for on-line continuing education?, Methods: The article describes the experience gained while creating self-assessment tools starting from the teaching material transmitted by the person in charge of a continuing medical education session, selected and an example for demonstration., Results: We present the various written tools for self-assessment: multiple-choice test and script concordance test (SC). These SC were based partly on a clinical case with various test formats: units of diagnosis, investigation and therapeutics. In connection with the example chosen, we propose a model for constructing on-line continuing medical education sessions, which could be used by persons in charge of such training sessions in neurosurgery and in other specialties., Conclusions: With the availability of on-line self-assessment tests round-tables videostreaming, this teaching method can be used to fulfil mandatory continuing medical education requirements.

Unlabelled: Acute gastroenteritis remains a frequent illness in infants and children with still important morbidity and mortality rates. Oral rehydratation solutions (ORS) and early refeeding are the main recommendations. Indication of drugs remains limited., Objective: To evaluate the management of acute diarrhea by private practice pediatricians of France., Methods: A questionnaire concerning ORS, dietary formula, antidiarrheal diet, antibiotherapy, antidiarrheal drugs was sent to all 2907 private pediatricians of France., Results: Six hundred twenty-nine questionnaires were analyzed (22%). Three hundred and ninety-seven pediatricians (63%) prescribed systematically an ORS, 294 (47%) changed formula, 412 (66%) prescribed a regimen. Antibiotic was prescribed after coproculture (81%), when glairy and bloody diarrhea (65%), associated infectious disease (63%), toxi-infectious syndrome (42%) or immunodeficiency were present (28%). Most pediatricians (97%) prescribed at least one drug: diosmectite (84%), Lactobacillus acidophilus (63%), Saccharomyces boulardii (62%), racecadotril (62%), loperamide (28%), attapulgite de Mormoiron (26%), nifuroxazide (20%). Drugs were prescribed more often for their effectiveness than for comfort., Conclusion: This study demonstrates the discrepancies that remain between recommendations and practical care in the treatment of acute diarrhea in children. Private French pediatricians often prescribe drugs.

Objectives: To analyse the results of delayed evaluation of European teaching sessions using a questionnaire provided by the French College of Anaesthesiologists., Study Design: Open evaluation., Material: Questionnaires were completed 3-6 months after European courses provided in November-December 1999., Method: The types of professional exercise and the medical practice as well as the theme of the courses were pointed out. The evaluation included six items noted from 1 to 10: usefulness of the abstract book, discussion with colleagues, discussion with a manager, decision to modify medical practice, application of that decision, own objectives fulfilled. The global mean score for each item was calculated. Results were compared according to the professional mode of exercise and the theme of the course., Results: 5/7 centres provided information. 91/239 questionnaires were returned to the organizers. The participants were working in different structures (private clinic: 25, university hospital: 31, general hospital: 27, PSPH: 8). The main exercise was anaesthesiology (75/77 answers). Means scores affected to the different items were around 7 for all but one of them. The mean score concerning discussion with a manager was significantly decreased to 3.5 +/- 3.2. Decision to modify their own practise was higher in private clinics compared to PSPH. The abstract book was more consulted after the first course (respiration and thorax)., Conclusion: 3-6 months following the FEEA courses the participants thought to have fulfil their objectives and declared to have modify their medical practise. The lack of discussion with a manager should be analysed.

Objective: There is little data available on current practice related to prescription of labile blood products (LBP) by French physicians. The aim of this study was to assess whether prescriptions were conform to Anaes (French Medicine's agency) guidelines, with regard not only to indications but also quality of the products, so as to define the improvements that could be made., Method: Thirty-four clinical case reports, classified by specialties were sent to prescribing physicians working in the regional health centers, from 17 different blood banks, from October 1997 to February 1998. The prescribers were requested to answer only the questions that were specific to their particular field of experience. Each case description included multiple choice questions on the indication for transfusion of concentrated of red blood cells (RBC) and/or platelets (CP) and/or plasma, and the possible requirements for specification or modification of the guidelines applicable to these products. The primary end point of analysis was the adequation of the answers to the Anaes recommendations., Results: Answers were obtained regarding 5092 clinical cases from 818 physicians. The participation rate was of 30%. The specialties were as follows: 34% anesthesiologists, 14% oncologists-haematologists, 13% internal medicine specialists, 11% emergency physicians, 10% paediatricians, 8% obstetricians, 7% geriatricians, and 3% transplantation surgeons. Eighty-two percent of the answers came from physicians working in the public health services. The adequation with the indication for transfusion was of 90.3% for RBC, 92.3% for platelets and 93.8% for plasma. The percentages of correct answers regarding the indications for specification or modification of the LBP were as follows: 90.3% were correct for irradiation (of either RBC or platelets); 68.8% and 53.2% respectively for leukocyte depletion from RBC and platelets; 64% for phenotyped RBC; 68.2% for compatibilized RBC; and 57.3% for apheresis platelet concentrates. There was no difference in results depending on the type of center, private or public, and the quality of LBP prescribed. The answers obtained from the anaesthesiologists' clinical cases were less accurate with regard to RBC but more accurate with regard to PC compared with other specialists., Conclusion: This study shows the correct management of the indications for transfusion by the prescribing physicians who participated in the study, but the lack of knowledge with regard to the indications for specifications and/or transformations of LBP. The respect of the indications for transfusion is the corner stone of safe transfusion and this phase should be optimized with improved dissemination of information on transfusion and training for the physicians and programs that would improve the quality.

Objectives: To analyse the results of the immediate evaluation of an European teaching session using a questionnaire provided by the French College of anaesthesiologists., Study Design: Open evaluation., Material: Questionnaires completed after each topic by 50 participants of an European course including 15 lectures were collected., Methods: The types of professional exercise and the medical practise reliable to the different topics were pointed out. The evaluation included 4 items noted from 1 to 10: new information for medical practise, definition of pedagogic objectives, quality of means used for teaching, interest for the treated subject. The global mean score for each item and for each speaker was calculated. Results were compared according to the professional mode of exercise, the own medical practise and the project to modify it in the future., Results: Scores affected to items were significantly lower for participants exercising in PSPH compared to general and university hospitals and private clinics (p < 0.001). New information was better found in case of poor or absence of practise, but interest was improved when medical practise was frequent. 2/3 of the participants projected to modify their practise after the session., Conclusion: The analysis of medical evaluation should allow to determine an acceptable zone of quality which may be useful for accreditation. However, distorting results according to the professional mode of exercise and the own medical practise should encourage the development of adapted continuous medical education. Delayed evaluation may be necessary to objective the putative benefits of CME on medical practise.

A survey was conducted among 250 graduates of the Bobigny School of Medicine (University Paris-Nord) who had completed medical school from 1986 to 1989 in order to ascertain their opinion concerning the training received. Ninety former students (36%) responded. The mean age of the sample was 34 years; 46 women and 44 men. Most (88.9%) were practicing medicine, principally as general practitioners (61.8%). 81.6% felt they had been well prepared to practice medicine. The rate of satisfaction was higher in the area of fundamental science than in clinical science. The responders generally felt that teaching and validation methods should emphasize real situations. The main criticism concerning the curriculum was an insufficient degree of professionalism, particularly in fields currently of particular importance: epide miology, health economics, education, prevention, office management. Training was also considered to be insufficient in medical techniques, communication, priority decision making, team work, emergency care, organization of time and handling stress. The responders suggested that the future curriculum should focus more on information search, research methodology and computer science. The results of this survey collaborate findings of recent retrospective long-term analyses conducted in other European countries.

The evaluation of continuing medical education (CME) courses will soon become one of the tools used to assess post-graduate training, particularly in compliance with the recent legislation. In 1997, the organization committee of the French congress of pneumology decided to analyze the different methodologies used to assess the congress CME courses. The analysis was based on a satisfaction questionnaire, a before-after assessment of 4 workshops, and a comparison between participants and non-participants in 3 plenary sessions. Mann-Whitney and Wilcoxon non-parametric tests were used for statistical analysis. Satisfaction scores were high. For the plenary sessions, test results were better for participants than for the non-participant controls and for the workshops, test results were higher after completion. This type of study can only evaluate the level of knowledge acquired and is subject to a selection bias. It cannot analyze the practical impact of the courses nor their effect on patient health. Such assessment methodologies should be used more widely in order to improve future training sessions.