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International audience; Les incitations à la recherche et à l’évaluation se multiplient en soins palliatifs. Pourtant, faute de formation initiale, le manque d’une certaine culture méthodologique des professionnels est un frein à leur développement. L’introduction en 2009 d’une épreuve de lecture critique d’un article médical (LCA) à l’examen classant national témoigne du fait que savoir lire un article scientifique est désormais reconnu comme l’une des compétences indispensables à transmettre aux étudiants en médecine. Cet article décrit tout d’abord en quoi consiste un enseignement de LCA, son intérêt et les limites de sa mise en oeuvre, pour ensuite ouvrir une réflexion sur l’adaptation de la LCA à l’apprentissage et à l’exercice de la médecine palliative. L’enseignement de la LCA vise la maîtrise des outils de recherche documentaire, la méthode de lecture rapide et les bases méthodologiques nécessaires pour la compréhension des informations scientifiques et l’analyse de leur validité. Cet enseignement est utile et nécessaire, en soins palliatifs comme dans tout autres spécialités médicochirurgicales. Néanmoins, il est fondé sur un paradigme (la médecine fondée sur le niveau de preuve) qui a montré ses limites et ses dérives : l’utilisation des concepts qui lui sont sous-jacents doit donc être réfléchie et adaptée aux contraintes et aux principes fondateurs des soins palliatifs. Cela ne peut s’envisager qu’avec une motivation forte et une ouverture franche des praticiens de soins palliatifs et des méthodologistes, conditions nécessaires à une réelle collaboration.; The incentives for research and evaluation are increasing in palliative care. However, lack of methodological skills among professionals is an obstacle to their development. In 2009, a test for critical appraisal of literature (CAL) was introduced as a part of the national residency examination for medical students. Reading a scientific article is now recognized as one of the skills necessary to convey to future doctors. This paper first describes what CAL is and what it means to teach it. Second, it addresses the question whether or not CAL should be integrated as a part of a training program in palliative medicine and how this is feasible. CAL skills concern information retrieval and basic methodological knowledge necessary for the understanding of scientific information and analysis of its validity. Such skills are useful and necessary in palliative care as they are in all other medical or surgical specialties. However,CAL is based on a paradigm (evidence-based medicine), which has proved to be as powerful as potentially dangerous. Its underlying concepts must be used with caution and adapted to the constraints and founding principles of palliative care. This supposes strong motivation and open-minded collaboration between palliative care practitioners and methodologists.

International audience; OBJECTIVES: To assess and understand adverse drug reactions (ADRs), a systematic review of reference databases like Pubmed is a necessary and mandatory step in Pharmacovigilance. In order to assist pharmacovigilance team with a computerized tool, we performed a comparative study of 4 different approaches to query Pubmed through ADR-drug terms. The aim of this study is to assess how an ontology of adverse effects, used to normalize and extend queries, could improve this search. MATERIAL AND METHOD: The ontological resource OntoEIM contains 58,000 classes and integrates MedDRA terminology. The entry point is a ADR-Drug term and the four methods are (i) a direct search on Pubmed (ii) a search with a normalized query enhanced with domain-specific Mesh Heading criteria, (iii) a search with the same elaborated query extended to the MeSH sub-hierarchy of the adverse effect entry and (iv) a search with a set of MedDRA terms grouped by subsomption in the OntoEIM ontology. For each of the 16 queries performed and analysed, relevant publications are selected "manually" by two pharmacovigilant experts. RESULTS: The recall is respectively of 63%, 50%, 67% and 74%, the precision of 13%, 26%, 29% and 4%. The best recall is provided by the ontology-based method, for 4 cases out of 16 this method returns relevant publications when the others return no results. CONCLUSION: Results show that an ontology-based search tool improves the recall performance, but other tools and methods are needed to raise the precision.

International audience; OBJECTIVE: The aim of this study was to evaluate antibiotic prescription in a French university hospital. DESIGN: Our hospital participated in an international European Surveillance of Antimicrobial Consumption (ESAC) project study, including a longitudinal survey of monthly antibiotic use between 1998 and 2005, and a point prevalence study in 2006. All patients in the hospital on the day of survey were included in the study. Antibiotic treatments were assessed according to local antibiotic guidelines. RESULTS: Between 1998 and 2005, antibiotic use increased from 551.9 to 628.5 defined daily doses per 1000 patient-days. This increase was linked to the increase of penicillin and fluoroquinolone consumption. In the point prevalence survey, 251 (27.0%) of the 930 included patients received one or several antibiotics for a total of 395 antibiotic prescriptions. Community-acquired infections were the first indication of treatment (41.8% of prescriptions), hospital-acquired infections accounted for 34.9% of prescriptions, surgical and medical antibiotic prophylaxis for 22.4%. The assessment of antibiotic prescriptions showed that 73.7% of them were in conformity with local recommendations. CONCLUSIONS: This type of study is relevant to identify critical points of inadequate antibiotic use so as to suggest corrective measures to prescribers.