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Background. There are 32 teaching hospitals in France, including 30 University hospitals and 2 Regional teaching hospitals. Teaching hospitals have three roles: health care provision, training of healthcare professionals, and medical research. These roles lead to frequent interactions with pharmaceutical and medical device companies, inevitably raising major risks of conflicts of interests. Therefore, policies to manage conflict of interests (COI) are crucial. This study aims to examine COI policies in French teaching hospitals. . Methods. All French teaching hospitals (n=32) were included in this study. All hospitals websites were screened for institutional COI policies and curriculum on COI, using standardized keyword searches. More data were collected through a questionnaire addressed to each chief executive officer (CEO) of the teaching hospital. We used predefined criteria (n= 20) inspired by similar surveys on COI policies in French, US and Canadian medical schools, with some additions to reflect the local hospital context. A global score for each hospital, ranging from 0 to 58 (higher scores denoting stronger policies) was calculated by summing points obtained for each criterion. Results. Three out of 32 (9%) CEOs replied to the questionnaire. All 32 hospitals had websites; 16 hospitals listed policies or regulations on their websites or provided them on request. In December 2017, among the 32 hospitals, we found that 17 (53.1%) had rules and regulations for some items only, 4 (12.5%) have considered implementing a policy, two of which (6.3%) have begun implementation. and 15 (46.9%) had no evidence of COI policies and a null score. The maximum global score was 24 out of 58, with a mean of 3.50 ± 5.72. Conclusion. This is the first systematic assessment of COI policies in teaching hospitals in France. Such policies are needed to protect patients, clinicians and students from undue commercial influence. Despite public and political pressure for better management of COI since France’s benfluorex (Mediator) scandal of 2010, few teaching hospitals have implemented comprehensive and protective policies. We hope that periodic ranking of hospitals will contribute to raise awareness of the importance of COI policy and speed introduction.

Background Indicators for the quality of palliative care are a priority of caregivers and managers to allow improvement of various care settings and their comparison. The involvement of patients and families is of paramount, although this is rarely achieved in practice. No validated assessment tools are available in French. Simple cultural adaption of existing questionnaires may be insufficient, due to the varying organization of care in different countries. The purpose of this study was to develop and validate a new instrument to measure the quality of palliative care and satisfaction from the patient point of view. Methods Results from a qualitative study were used by a multi-professional workgroup to construct an initial set of 42 items exploring six domains. A cross-sectional survey was conducted in seven hospitals, encompassing three care settings: two palliative care units, one palliative care hospital, and four standard medical units with a mobile palliative care team. All items were assessed for acceptability. We conducted exploratory structural analysis using Principal Component Analysis (PCA), and evaluated external validity by comparison against global rating of satisfaction and the MD Anderson Symptom Inventory (MDASI) questionnaire. Results A total of 214 patients completed the questionnaire. After removing 7 items from the response distribution, PCA identified eight interpretable domains from the 35 final items: availability of caregivers, serenity, quality of information, pain management, caregivers’ listening skills, psychosocial and spiritual aspects, possibility to refuse (care or volunteers), and respect for the patient. Internal consistency was good or acceptable for all subscales (Cronbach’s α 0.5–0.84), except the last one (0.15). Factorial structure was found globally maintained across subgroups defined by age, sex, Palliative Performance Scale (PPS ≥ 60%, 40–50% and ≤ 30%), and care settings. General satisfaction was inversely correlated with the 2 scores of the MDASI questionnaire: symptoms’ severity and impact on life. Each subscale, except “possibility to refuse”, correlated with general satisfaction. Conclusions Quali-Palli-Pat appears to be a valid, reliable, and well-accepted French tool to explore the quality of care and the satisfaction of palliative care patients. It should be confirmed in a wider sample of care settings. Trial registration clinicaltrials.gov NCT02814682, registration date 28.6.2016. Electronic supplementary material The online version of this article (10.1186/s12904-019-0403-z) contains supplementary material, which is available to authorized users.

International audience; Context: Relatives of patients receiving palliative care are at risk for psychological and physical distress, and their perception of quality of care can influence patients' quality of life. Objectives: The purpose of this study was to develop and validate the QUALI-PALLI-FAM questionnaire (QUAlity of PALLIative car from FAMilies' perspective) to measure families' perception of and satisfaction with palliative care. Methods: An exploratory factor analysis was conducted, and we evaluated the questionnaire's internal consistency using Cronbach's alpha, its stability across various strata, and the correlation between the QUALI-PALLI-FAM (factors, total score, and global satisfaction) and the total score of the FAMCARE (FAMily satisfaction with CARE) questionnaire. Results: This multicentric prospective cross-sectional survey was conducted in seven French hospitals, namely, three palliative care units and four standard medical units with a mobile palliative care team. The questionnaire was completed by 170 relatives of patients (more than 90% of patients had advanced cancer). The final questionnaire included 14 items across three domains: organization of care and availability of caregivers, medical information provision, and confidence and involvement of relatives. Internal consistency was good for all subscales (Cronbach's α = 0.74–0.86). Our questionnaire was stable across various strata: age and gender (patients and relatives), Palliative Performance Scale scores, and care settings. The QUALI-PALLI-FAM total score was correlated with the total FAMCARE score. Conclusion: The QUALI-PALLI-FAM appears to be a valid, reliable, and well-accepted tool to explore relatives' perception of quality of inpatient palliative care and complements the QUALI-PALLI-PAT questionnaire. Further testing is required in various settings and countries.

Background Medical faculties have a role in ensuring that their students are protected from undue commercial influence during their training, and are educated about professional-industry interactions. In North America, many medical faculties have introduced more stringent conflict of interest (COI) policies during the last decade. We asked whether similar steps had been taken in France. We hypothesized that such policies may have been introduced following a 2009–2010 drug safety scandal (benfluorex, Mediator) in which COIs in medicine received prominent press attention. Methods We searched the websites of all 37 French Faculties of Medicine in May 2015 for COI policies and curriculum, using standardized keyword searches. We also surveyed all deans of medicine on institutional COI policies and curriculum, based on criteria developed in similar US and Canadian surveys. Personal contacts were also consulted. We calculated a summary score per faculty based on 13 criteria. [range 0–26; higher scores denoting stronger policies] Results In total, we found that 9/37 (24%) of French medical schools had either introduced related curriculum or implemented a COI-related policy. Of these, only 1 (2.5%) had restrictive policies for any category. No official COI policies were found at any of the schools. However, at 2 (5%), informal policies were reported. The maximum score per faculty was 5/26, with 28 (76%) scoring 0. Conclusion This is the first survey in France to examine COI policies at medical faculties. We found little evidence that protection of medical students from undue commercial influence is a priority, either through institutional policies or education. This is despite national transparency legislation on industry financing of health professionals and limits on gifts. The French National Medical Students Association (ANEMF) has called for more attention to COI in medical education; our results strongly support such a call.

The aim of our study was to evaluate pain frequency, intensity, and disability levels in a population with neuromuscular disorders (NMD). Of 862 questionnaires mailed to outpatients treated at 10 centers, 511 (300 men and 211 women) responded with answers suitable for analysis (response rate: 59.3%). Patients had Duchenne or Becker muscular dystrophy, type 1 myotonic muscular dystrophy, facioscapulohumeral muscular dystrophy, metabolic myopathy, or myasthenia gravis (MYA). The questionnaire packet included numeric scales for pain intensity and relief, the Brief Pain Inventory, the Saint Antoine Pain Questionnaire, and a scale to assess disability. More than two-thirds of the 331 patients (67.3%) suffered pain during the last three months. The mean number of days with pain was 18.4±15.1 days. The mean pain intensity was 4.8±2.5. Pain was usually diffuse (153 patients, 44%) and intermittent (228, 71%). Pain intensity varied by the NMD diagnosis; the most severe pain was observed in metabolic myopathy (13/27 patients suffered severe pain, 49%) and in MYA (16/42, 38%). Approximately three-quarters of patients had fewer than 10 days of inactivity due to pain during the last three months, and 98% had fewer than 30 days. Our study indicates that pain is frequent in hereditary muscle disorders and MYA. Mean intensity is moderate. Pain in NMD patients should be systematically assessed.

Background-objectives The medical oncology department of Saint Antoine Hospital has several inpatient units: day hospital, week hospital, and traditional hospital, including nine beds for palliative care. The importance of patient flow between the various units and the need to provide better care at all stages of cancer has led to introduce in 2007 a program to improve the quality of care, initially in form of Morbidity-Mortality reviews. The objectives are (1) identify situations or practices of care, prescription or organisation recognised as inadequate and requiring corrective action within a short time. (2) improve the quality of care for cancer patients heavily pre-treated by limiting chemotherapies administered at a too advanced disease (3) initiate a process for evaluating professional practices. Program/description Since November 2007, a meeting is held every 3 months. A medical coordinator is responsible for organising the meeting. One of the indicators initially chosen was the proportion of patients who received chemotherapy within 14 days preceding their death in the department. Every 3 months, the data from these patients were analysed to discuss the appropriateness of prescribing chemotherapy. On the other hand, during these meetings are reported events or situations deemed inappropriate in the care of patients hospitalised on the basis of the statement of one or more members of medical team. Results The implementation of the program for quality improvement has yielded the following results: Significant reduction in patients receiving chemotherapy in the 14 days preceding death Reduction in incidence of infections of implantable catheter: when changing referencing parenteral nutrition in the hospital, there was a significant increase in infections of implantable catheter in the oncology department. A tracking has been done, to highlight a flaw in the handling of parenteral bags. Corrective action permitted to rectify the practice and reduce the incidence of catheter infections in a chort period of time. Establishment of a form of aid to prescribing controlled analgesia pump, to increase the number of patients having access to this type of administration of morphine. Establishment of a form of intensive care, to anticipate the discussion on a possible transfer to intensive care unit in case of acute deterioration of clinical condition. Each form must be completed at each hospital admission and discussed again at least once a week. The implementation began on 1 November 2009. An evaluation will be conducted after 6 months of use. Discussion The program to improve the quality of care in oncology based on feedback from experience improved the daily practices. Improving the quality of care concerned not only nursing (implantable catheter), but also the medical decision making process (chemotherapy in frail patients hospitalised) and the organisation of care (definition of level of intensity of care). One of the strengths has been to open the meetings with other caregivers (healthcare executives, nurses, psychologists). Areas for improvement are to open this program to areas of Day Hospital and consultation by tracing the feedback. Finally, a program to avaluate the indications of parenteral nutrition in hospitalised patients is underway, as well as the establishment of an ‘emergency bed’ for palliative patients admitted directly into the service, avoiding the admission through an emergency unit, source of discomfort. Contexte-objectifs Le service d9oncologie medicale de l9hopital Saint Antoine possede plusieurs unites d9hospitalisation: hopital de Jour, hopital de semaine, hospitalisation traditionnelle, comprenant 9 lits identifies de soins palliatifs. L9importance du flux des patients entre les differentes unites et la necessite d9apporter une amelioration des soins a tous les stades de la maladie cancereuse a conduit a mettre en place en 2007 un programme d9amelioration de la qualite des soins, initialement sous forme de Revues de Morbidite-Mortalite pluriprofessionnelles. Les objectifs sont de (1) depister les situations ou pratiques de soin, de prescription ou d9organisation reconnues comme inadequates et necessitant des mesures de correction dans un delai bref. (2) ameliorer la qualites de prise en charge des malades cancereux lourdement pre-traites en limitant les prescriptions de chimiotherapie a un stade trop avance de la maladie (3) initier une dynamique d9evaluation des pratiques professionnelles. Programme/description Depuis novembre 2007, une reunion a lieu tous les 3 mois. Un coordonnateur medical est charge d9organiser la seance. Un des indicateurs choisi initialement a ete la proportion de patients ayant recu une chimiotherapie dans les 14 jours precedant leur deces dans le service. Les donnees proviennent de donnees PMSI. Tous les 3 mois, les dossiers de ces patients sont analyses afin de discuter de la pertinence de la prescription de cette chimiotherapie. D9autre part, lors de ces reunions sont signales des evenements ou situations jugees comme inadequates dans la prise en charge des patients hospitalises, sur la base de la declaration de l9un ou de plusieurs des membres de l9equipe medicale. Resultats La mise en place du programme d9amelioration de la qualite a permis d9obtenir les resultats suivants: Reduction significative de patients recevant une chimiotherapie dans les 14 jours precedant le deces Reduction d9incidence des infections de catheter implantable: lors d9un changement de referencement de poches de nutrition parenterale au sein de l9hopital, il est apparu une augmentation importante des infections des sites implantables dans le service d9oncologie. Un travail de tracabilite a donc ete effectue, permettant de mettre en evidence un defaut lors de la manipulation des poches. Une mesure correctrice a permis de rectifier la pratique et reduire l9incidence des infections. Mise en place d9un formulaire d9aide a la prescription de Pompe d9Analgesie Autocontrolee, permettant d9augmenter le nombre de patients ayant acces a ce type d9administration de morphiniques. Mise en place d9un formulaire d9intensite de soin, afin d9anticiper la reflexion sur un eventuel transfert en soins intensif lors d9une aggravation brutale de l9etat clinique. Chaque formulaire doit etre rempli lors de chaque hospitalisation, et rediscute au moins une fois par semaine. La mise en place a debute le 1° novembre 2009. Son evaluation sera realisee apres 6 mois d9utilisation. Discussion Le programme d9amelioration de la qualite des soins en oncologie a partir des retours d9experiences a permis une amelioration des pratiques. L9amelioration de la qualite de la prise en charge a concerne non seulement les soins infirmiers (soins de sites implantables), mais egalement la prise de decision medicale (chimiotherapie chez les patients hospitalises precaires) et l9organisation des soins (definition du niveau d9intensite de soins). L9un des points forts a ete d9ouvrir ces reunions aux autres soignants (cadres de sante, infirmieres, psychologues). Les points a ameliorer sont d9ouvrir ce programme aux secteurs d9Hopital de Jour et consultation en faisant remonter des retours d9experience. Enfin, un programme d9evaluation des indications de nutrition parenterale chez les patients hospitalises est en cours, de meme que la discussion de la mise en place d9un lit d9urgence palliative destine a admettre les patients directement dans le service en evitant le passage par le service d9accueil des urgences.