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L'exercice coordonné en soins primaires est un enjeu majeur pour notre système de santé. Le travail en interprofessionnalité a démontré depuis longtemps ses bénéfices, à la fois pour les patients et les acteurs de santé. Néanmoins, cette démarche ne va pas de soi. Il est nécessaire d'apprendre à travailler ensemble grâce à l'éducation interprofessionnelle. Interprofessional teamwork in primary care is a major issue for health systems. Interprofessional collaboration has demonstrated for a long time its benefits for patients and healthcare professionals. However, this new way of exercise is difficult. It is necessary to learn to work together through interprofessional education. [ABSTRACT FROM AUTHOR]

Résumé Des équipes dédiées réalisent des transports médicalisés pédiatriques et néonatals depuis la fin des années 70 en France. Le Groupe francophone de réanimation et urgences pédiatriques (GFRUP) a réalisé un état des lieux en 2017 sur la situation en France métropolitaine. Il en ressort qu'il y a maintenant dans chacune des 12 régions métropolitaines au moins 2 équipes de SMUR pédiatrique. Le mode de fonctionnement et l'activité varient beaucoup d'une équipe à l'autre. Cela va de quelques centaines de transports à près de 2000. Les équipes réalisant le plus de transports sont en général dédiées, alors que les autres sont détachées « à la demande » de la réanimation à laquelle elles appartiennent. L'âge limite des enfants transportés varie aussi, certains SMUR ont une activité exclusivement néonatale et, d'autres transportent les enfants jusqu'à 18 ans. Les SMUR pédiatriques évoluent en « s'appropriant » des techniques réservées jusqu'à présent aux services de réanimation, les exemples en sont la ventilation par oscillation à haute fréquence, l'hypothermie thérapeutique active, l'assistance circulatoire extracorporelle et l'échographie transthoracique. La formation initiale et continue, médicale et paramédicale, fait partie des missions universitaires confiées aux SMUR pédiatriques. La place des parents lors des soins est une problématique qui s'est imposée en réanimation et il en est de même pour les équipes de transport. En presque un demi-siècle le rôle des SMUR pédiatriques a grandement évolué, de structure de sauvetage en dernier recours ils sont devenus un maillon rationnel de la chaîne de soins pédiatriques au sein des réseaux régionaux. Summary Dedicated teams perform neonatal and pediatric transports since the late 70s in France. In 2017, Groupe francophone de réanimation et urgences pédiatriques (GFRUP) has ordered a survey about the French organization of pediatric retrieval teams. There are at least two teams in each of the 12 regions of metropolitan France. The amount of transfers varies widely from one team to another (a few hundreds to nearly 2000). Teams performing most transfers are dedicated while the other ones are "on demand". There is a great variation in the age limit: exclusive neonatal team for some and until 18 years for others. Pediatric retrieval teams are able to use sophisticated techniques which used to be usable only in intensive care unit like ventilation with high frequency oscillation, active therapeutic hypothermia, extracorporeal membrane oxygenation and trans-thoracic echocardiography. Initial and continuing training are part of the duty of many university retrieval teams. Family centered care is now a key point in transfers' management. In half a century, neonatal and pediatric transport has widely evolved, and is now a recognized part of the healthcare chain inside perinatal and pediatric networks. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Il existe peu de données sur la pratique de l’anesthésie locorégionale périphérique (ALRp) par les anesthésistes en formation en France, notamment depuis l’utilisation de l’échographie. Nous avons étudié les pratiques en ALRp des internes d’anesthésie-réanimation dans la région Poitou-Charentes. Type d’étude: Étude prospective descriptive multicentrique. Patients et méthodes: Les internes en anesthésie-réanimation ont complété un formulaire d’enquête après réalisation d’une ALRp. Résultats: Un total de 394 procédures ont été réalisées par 21 internes dans quatre hôpitaux. Le nombre et le volume médian d’anesthésique local administré par type d’ALRp sont : axillaire 245–25mL (62 %), interscalénique 29–21mL (7 %), supraclaviculaire 1–25mL (0,3 %), infraclaviculaire 2–25mL (0,5 %), fémoral 65–18mL (16,5 %) et sciatique 52–22mL (13 %). Le repérage a utilisé l’échographie seule pour 365 (93 %) des procédures et la neurostimulation seule pour 23 d’entre elles (6 %). La durée de la procédure a été inférieure à cinq minutes pour 200 (50,7 %) procédures et supérieure à 15minutes pour seulement 16 d’entre elles (4 %). Une seule ponction a été nécessaire pour 307 (78 %) des procédures. La réussite initiale du bloc a été obtenue pour 369 (93 %) procédures. Les internes en fin de cursus mettent moins de temps (p <0,0001), ont recours à moins de ponction (p <0,046) et se servent moins souvent de la neurostimulation (p <0,0001) sans différence concernant le taux de succès et le volume d’anesthésique local utilisé. Conclusion: La majorité des procédures d’ALRp effectuées par les internes dans la région Poitou-Charentes sont réalisées sous repérage échographique seul. La procédure est rapide, ne nécessitant le plus souvent qu’une seule ponction, et a un taux de réussite élevé, notamment chez les étudiants les plus expérimentés. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess both level and type of the initial training on regional anesthesia for French residents after the publication of formalized recommendations of experts on training and practice in regional anesthesia in 2006. Study design: Practical statement enquiry. Material and methods: A multiple choice questionnaire was sent to all the French residents in anesthesiology. Questions are focused on demographic data (year of training, university hospital origin, theoretical training, type and length of practical courses) and regional anesthesia practice, particularly about the essentials of regional anesthesia techniques for initial training, level of practice and degree of autonomy, especially for the 5th and the 3rd years students. After sending, two follow-ups were done, responses were obtained by mail or post. Results: The global answer rate was 29.1% (25.3% and 23.4% for the 5th and the 3rd years respectively). Concerning theoretical training, 29% of responders had anatomy course, 33% dissection and 38% a supplemental training. At the end of initial training, the official goal (30 acts for a specific technique) was achieved in 98% of cases for epidural anesthesia, 95% for spinal anesthesia, 82% for both axillary and humeral block and 72% for femoral block, with a declared 100% autonomy at this level. Conclusion: The main goal of the formalized recommendations on training and practice in regional anesthesia is partially reached. This apparent failure can be due to both a lack of regional anesthesia exposure, inadequate faculty training, usual slavery to routine, or technical evolution of medical practice. [Copyright &y& Elsevier]

Abstract: Introduction: The duration of Anesthesiology and Intensive Care (AIC) residency increased from four to five years in 2002 in France. AIC is a specialty increasingly chosen in relation to medical and surgical specialties. We conducted a national survey by questionnaire on the evaluation of their theoretical and practical training by the French residents. Material and methods: A questionnaire (demographics, motivations for the choice, training) was sent to 1422 residents, enrolled since 2002, in each province. Results: In total, 562 questionnaires (40 %) were returned. The mean age of residents is 28±2 years, 46 % are women, on average in 6th semester [1–10th]. The obtained specialty was their first choice for 90 % and of the obtained city home for 73 %. Residents declare that the place of their definitive installation will be chosen depending on the quality of life mainly. So, 97 % referred the same choice of specialty. Training in locoregional anaesthesia (LRA) was evaluated correct or good by 53 % of residents and in the management of difficult intubation correct or good by 62 %. Theoretical training was assessed correct by 31 % of responders and good by 53 % and practical training correct by 25 % and good by 61 %. Discussion: The AIC is now a specialty of positive choice by students. This choice is reinforced by teaching and practice during the residency. The global training is as good as a whole. Residents wish to deepen in some areas (ultrasound, LRA, critical reading, medical redaction) and an evaluation of their practical training with simulations. Conclusion: French AIC residents seem satisfied with almost all their training and referred the same choice of specialty. [Copyright &y& Elsevier]

Objective. – We surveyed the residents in their first (R1) and fourth (R4, last) years of residency in anaesthesia and intensive care in France.Methods. – The questionnaires mailed to each resident were designed to obtain personal data, motivation for specializing in anaesthesia and their opinion of their training.Results. – The response rates were 48% for the R1 residents and 77% for the R4 residents. There were 40% females in this population and the R1 residents were 25 ± 1 year old, 29 ± 2 year-old for the R4 residents. Almost half (46%) of the R1 responders were married as were 74% of the R4 residents. They spent an average of € 726 each year on books, computers and other educational items. Most (71%) had opted for anaesthesia after considering other medical specialties, but only 12% had considered surgery. Half (51%) were on a training program that was far away from their home. They thought highly of their training, with the clinical training being rated above the non-clinical component. About half of them had obtained specialized certificates (mainly additional certification in intensive care and antibiotic therapy) during their residency. Two thirds of those in R4 expected to work in a public hospital and about one third expected to work in intensive care. Money was an important factor in their choice of profession. A majority planned to remain in the area where they had graduated in anaesthesia after their residency. Finally, 96% declared that they would choose anaesthesia again if they had to do so.Conclusion. – French residents in anaesthesia are satisfied of their initial choice for anaesthesia and don''t regret it at the end of their residency training. [Copyright &y& Elsevier]

The replies of 15 countries to the questionnaires—training and education—have shown that transfusion medicine teaching and education regarded as a definitely clearly defined specialty with different tones and degrees, is to be considered at different levels relating to teaching basic knowledge of transfusion medicine during the education as well as in the postgraduate training. The reported results may serve as an incentive or impulse to suitable regulations and a common consensus of transfusion medicine curriculum although each European Country has its peculiarities. [Copyright &y& Elsevier]

Abstract: After three decades of practice in the field of allergy and clinical immunology, the increasing demand of patient care in allergy, together with the increased need for the training of medical generalists and specialists, have led us to develop a continuing medical education program in this field. This 24-month program, which now exists in Algiers, leads to certification in allergy/immunology. Professors from Algerian and foreign universities contribute to it. The majority of the allergy clinics which may be involved do not at present meet all the criteria of accreditation but it is anticipated that these criteria will be met in the coming years due in large part to this introductory program, together with the continuing medical education that has been available in our country since 1990. [Copyright &y& Elsevier]