Search

Background Since the law of February 11, 2005, in France, the number of children with disabilities enrolled in ordinary schools has increased steadily. As a result, the amount of personal support provided by a special needs assistant (personal support) is also increasing. The aim of the study was to describe the diseases and impairments of disabled children aged 2–6, enrolled in mainstream schools and benefiting from personal support for schooling by special needs assistants in the Bouches-du-Rhone (France) in 2014. Methods A cross-sectional descriptive study was performed. Children included were benefiting from either an individual or shared personal support. Physicians from the territorial organization in charge of disability coded diseases and deficiencies using the International Classification of Diseases, 10th revision, and nomenclature inspired by the International Classification of Functioning, Disability and Health. Results Medical data were coded for 990 children out of 1260 of the total population. These young disabled children were most frequently children with pervasive developmental disorders (23.3%), lack of expected normal physiological development (19.9%), or mixed specific developmental disorders (13.5%), and most often had behavioral, personality, and relational skills disorders (61.8%), psychomotor function impairments (51.9%), or written or oral language learning impairment (43.2%). Finally, the two main types of impairments most represented among these children were psychological impairments (86.7%) and language and speech impairments (79.8%). The children were most often supported by an individual personal support (for one child only) than by a shared personal support (60% vs. 40%). They were mainly boys (almost 75%). Conclusion This study provides working guidelines for the management of health policies relating to disability at the territorial or even national level.

Objectif : Le Programme de Développement Affectif et Social (PRODAS) est un programme de développement des compétences psychosociales des enfants ou adolescents mis en œuvre depuis 2005 en milieu scolaire par une association française (le Planning familial). L’objectif de cet article était de synthétiser les connaissances sur les effets de ce programme, afin de contribuer à l’étude de sa transférabilité. Méthodes : La revue de littérature réalisée a porté sur des études datant de 1970 à 2017. Ont été interrogées les bases de données : ScienceDirect, PsycNET, ERIC, PsycINFO, erudit, ISIDOR, Cochrane. Les mots clés utilisés étaient « Human Development Program » ou « PRODAS ». Résultats : Une amélioration, le plus souvent significative, des compétences émotionnelles et sociales des enfants et des adolescents était rapportée. Une relation de type dose-effet était également suggérée par certains résultats. Peu de données étaient disponibles chez les jeunes enfants (école maternelle) et aucune étude n’explorait les effets du programme à long terme. Conclusion : Cette synthèse a permis de mettre en lumière les principaux effets du PRODAS. Toutefois, considérant que ce programme est un des seuls à s’adresser aux enfants dès 4 ans en France, de futures études portant sur des enfants d’écoles maternelles, avec un suivi à long terme, seraient utiles pour compléter les données sur l’efficacité d’un tel programme.

Research question Does fresh embryo transfer after IVF with or without intracytoplasmic sperm injection (ICSI) increase the small for gestational age (SGA) rate, and frozen embryo transfer (FET) after IVF with or without ICSI increase the large for gestational age (LGA) rate versus natural conception? Design Retrospective comparison of an exposed historical group/cohort involving singletons conceived after fresh embryo transfer and after FET with an unexposed group/cohort involving singletons conceived after a natural conception. Results A total of 1961 fresh embryo transfer babies and 366 FET babies were compared with 6981 natural conception babies. The SGA rate in fresh embryo transfer babies was not significantly different to natural conception babies (6.9% versus 6.8%, P = 0.856). This outcome was not influenced by the fresh embryo transfer (adjusted odds ratio [aOR] 1.0; 95% confidence interval [CI] 0.8–1.3), but rather by a low rate of multiparity (aOR 0.5; 95% CI 0.3–0.7), advanced maternal age (aOR 1.1; 95% CI 1.0–1.2), maternal underweight (aOR 1.5; 95% CI 1.1–2.1), maternal smoking or cessation during pregnancy (aOR 1.8; 95% CI 1.4–2.3), pre-existing hypertension (aOR 2.3; 95% CI 1.3–4.1) and pregnancy-induced hypertension (aOR 2.5; 95% CI 1.7–3.7). The LGA rate in FET babies was significantly different from natural conception babies (6.6% versus 3.2%, P = 0.012). This outcome was influenced by the transfer of frozen embryos (aOR 2.2; 95% CI 1.3–3.8) and by a high maternal weight (aOR 1.9; 95% CI 1.1–3.6). Conclusions Maternal background and obstetric parameters are more likely to influence the SGA rate than fresh embryo transfer conception. FET conception could be associated with an increase in LGA rate.

What is the perception of health and well-being of adolescents from an assisted reproductive technology (ART) cohort? We conducted a survey, from September 2015 to June 2016, through self-completion questionnaires, on 487 singleton or twin ART-conceived 11- to 15-year-old adolescents, followed up since 1994, as part of an ART cohort. Collected data concerned perinatal characteristics, health indicators and perception, eating habits, behavior, and living standards. A total of 60.6% of the questionnaires were returned and could therefore be analyzed. This concerned 295 adolescents who were representative of the 788 remaining adolescents of our cohort, in terms of type of ART, maternal and perinatal characteristics, but not gender (sex ratio = 0.77). Overall, 15.3% reported chronic diseases, and only 13.3% of them considered that their chronic disease had an impact on their school life. Moreover, 94.2% of adolescents perceived that their health was "excellent" or "good"; 97.3% adolescents had normal weight or were underweight; onset of menstruation was 12 years old (± 1) for girls, age usually reported for puberty in girls; 51.9% declared having regular physical activity, boys more frequently than girls. Moreover, 70.6% of the boys had a sedentary behavior compared to 44.8% of the girls. A total of 73.5% of the adolescents were stressed at school, but school demand was considered high only in 12.2% of cases. Finally, 90% declared to have high life satisfaction. Overall, ART does not appear to have particular effect on the health indicators and behavior of adolescents who participated in the survey except for higher family affluence scale.

Objectif : Etudier l’acceptabilite qu’ont les medecins generalistes (MG) du dossier medical partage (DMP), dans le contexte de la prise en charge des personnes sans chez-soi (PSCS).Methodes : Etude mixte sequentielle, qualitative puis quantitative. Pour la phase qualitative, des MG impliques dans la precarite ont ete interviewes par entretiens semi-diriges. Pour la phase quantitative 150 MG marseillais ayant une pratique typique de la medecine generale ont ete tires au sort puis interroges via un questionnaire. L’acceptabilite pratique et sociale du DMP etait quantifiee par echelles de Likert.Resultats : 19 MG ont ete interviewes pour la phase qualitative et 105 MG ont ete inclus (73 % de repondants) pour la phase quantitative. Les MG connaissaient mal le DMP. La moitie (52,5 %) des MG seraient prets a utiliser le DMP pour les PSCS. Il etait percu comme pouvant ameliorer la continuite des soins, sa qualite et sa securite pour les PSCS. L’interet du DMP etait percu superieur pour les PSCS que pour les patients en general, notamment sur le gain de temps envisage (p = 0,03). En revanche, le DMP etait mal connu, et les MG craignaient un detournement et une securisation insuffisante du stockage des donnees. Des limites specifiques aux PSCS etaient relevees, dont l’acces pratique au DMP pour les PSCS (carte vitale, acces internet).Conclusion : Le DMP pourrait etre une solution pour ameliorer la continuite des soins des PSCS. Il faut cependant adapter l’outil a la prise en charge des PSCS et informer les professionnels pour une utilisation effective.

The literature presents conflicting results on the epigenetic effect of in vitro fertilization (IVF) on the short-term and mid-term growth of children. These contradictory results may be related to the use of heterogeneous methodologies and non-longitudinal data. The goal of this study was to compare the body mass index (BMI) of children conceived via IVF and spontaneous conception (SC) children, using longitudinal data from birth to 5 years.This study compared 118 singleton children born after in vitro fertilization, with or without intracytoplasmic sperm injection (ICSI), selected from a pre-existing single-center cohort to 320 SC children from the same geographic area. BMI and its evolution were analyzed using the mixed-effect model during three periods: before standing acquisition (from birth to 1 year of age), during standing acquisition, and the following period from 2 to 5 years of age.BMI means were not significantly different between groups regardless of the period, when adjusting for confounding factors related to parents, pregnancy, and children's characteristics and lifestyle. Nevertheless, during the standing acquisition period, children born after IVF-ICSI presented a less significant decrease in BMI (P0.05). In addition, for each period we identified influencing factors (maternal BMI, level of wealth indicator) associated with BMI.In the study population, the suspected epigenetic influence of IVF reported in the literature was not observed for BMI from birth to 5 years of age. Further investigations need to be conducted to determine if the suspected influence of IVF on adiposity could be expressed through other parameters.

Resume Objectif Il s’agit d’analyser et de comparer la survie entre les patients en insuffisance renale chronique terminale traites initialement en dialyse peritoneale (DP) et ceux en hemodialyse (HD). Methodes L’etude a ete realisee a partir d’une cohorte retrospective basee sur les donnees de la region francaise Provence-Alpes-Cote d’Azur (PACA) issues du Reseau epidemiologique et information en nephrologie. Tous les nouveaux patients en insuffisance renale chronique terminale âges d’au moins 18 ans et ayant demarre un premier traitement par dialyse entre le 1er janvier 2004 et le 31 decembre 2012 en region PACA ont ete inclus. Les patients ont ete suivis jusqu’au 30 juin 2014. La methode de Kaplan-Meier et le test du log-rank ont ete utilises afin d’estimer la survie et de comparer les courbes de survie. L’analyse multivariee de Cox a ete realisee. Le score de propension a ete utilise. Principaux resultats L’analyse de la cohorte globale ne montre pas de difference de survie entre les malades traites par HD et ceux traites par DP, meme apres l’ajustement sur le score de propension. En revanche, lorsque les patients ayant eu un changement de technique sont exclus, la survie est meilleure chez les patients HD. Selon l’analyse multivariee, l’âge avance et l’absence d’autonomie a la marche sont associes a une augmentation de la mortalite chez les dialyses. L’hypertension arterielle est un facteur protecteur dans notre cohorte. Conclusion La survie de patients est similaire entre HD et DP.

Resume Objectif L’objectif principal de cette etude etait de determiner les raisons invoquees par les femmes ayant change ou suspendu leur methode de contraception en 2013. Quelle influence avait la controverse autour des estroprogestatifs (EP) de 3 e et 4 e generation de 2013 et l’avis de leur medecin ? Outre les modifications de methode contraceptive, percevaient-elles des consequences de la controverse sur leur mode de vie ? Ressentaient-elles un impact sur leur comportement vis-a-vis des professionnels de sante ? Methodes Une enquete a ete effectuee aupres de femmes en âge de procreer et domiciliees dans les Bouches-du-Rhone. Le recueil des donnees avait lieu entre le 4 novembre et le 16 decembre 2013. Etaient inclus les sujets de sexe feminin, d’âge compris entre 18 et 55 ans revolus. Les sujets etaient interroges par le biais d’un auto-questionnaire anonyme distribue dans le cadre d’officines pharmaceutiques. Le protocole prevoyait la construction de regroupements : les patientes declarant avoir pris connaissance de la controverse constituaient le groupe « expose », et les autres le groupe « non expose ». Il devait etre compare entre les deux groupes : le taux de sujets declarant avoir modifie ou suspendu leur contraception en 2013 et sans ou contre l’avis d’un medecin. Resultats L’echantillon comportait 988 sujets. L’âge moyen etait de 34 ans. Le niveau d’exposition aux debats mediatiques etait de 86,5 %. Parmi les femmes interrogees, 19,8 % etaient sous EP de 3 e ou 4 e generation en 2012, donc directement concernees par les debats et recommandations. Parmi les patientes, 38,5 % declaraient avoir realise une modification ou une suspension de leur contraception en 2013, et lorsqu’elles confirmaient avoir pris connaissance de la controverse, 40,1 % affirmaient avoir mene cette demarche sans ou contre l’avis d’un medecin. Cette proportion chutait a 18,2 % chez celles qui n’etaient pas au fait de la controverse. La mediatisation du sur-risque vasculaire n’etait pas plus evoquee chez les patientes ayant suspendu toute contraception medicale que chez les patientes declarant un simple changement de methode. Au total, 52,1 % des femmes ayant cesse leur contraception indiquaient que ce choix etait en partie le fait d’un changement dans leur sexualite ou vie reproductive. Ce motif n’etait invoque que chez 19,0 % des femmes ayant effectue un simple changement de methode contraceptive. Parmi les representations des femmes, la controverse faisait partie des raisons d’un changement de contraception dans 418 % des cas, tandis que l’avis d’un medecin n’entrait en jeu que chez 19,9 % des femmes. Il etait constate un recul de 11,0 % de la contraception orale entre 2012 et 2013, quasiment superposable a celui des EP oraux de 3 e et 4 e generation (10,6 %). En revanche, l’utilisation d’EP de 1 re et 2 e generation stagnait : leur hausse etait de 0,4 %. Au-dela de tout changement de contraception, 66,9 % des femmes exprimaient l’absence d’un impact quelconque de la controverse sur leur comportement. Parmi les femmes, 6,1 % temoignaient d’une perte de confiance en certains professionnels de sante. Conclusion Nous avons mis en evidence comment les patientes ayant change ou suspendu leur contraception au cours de l’annee 2013 placaient l’influence de l’affaire au premier rang des raisons de leur decision. Bien qu’un motif medical ait ete frequemment invoque, une femme sur cinq seulement estimait que l’avis de son medecin avait clairement contribue a son choix. L’influence des medias semblait empieter sur la relation medecin–patient, fondamentale a la qualite d’une prise en charge au long cours.

To assess the acceptability for GPS to use the French shared Electronic Health Record (Dossier Médical Partagé, "DMP") when caring for Homeless People (HP).Mixed, sequential, qualitative-quantitative study. The qualitative phase consisted of semi-structured interviews with GPs involved in the care of HP. During the quantitative phase, questionnaires were sent to 150 randomized GPs providing routine healthcare in Marseille. Social and practical acceptability was studied by means of a Likert Scale.19 GPs were interviewed during the qualitative phase, and 105 GPs answered the questionnaire during the quantitative phase (response rate: 73%). GPs had a poor knowledge about DMP. More than half (52.5%) of GPs were likely to effectively use DMP for HP. GPs felt that the "DMP" could improve continuity, quality, and security of care for HP. They perceived greater benefits of the use the DMP for HP than for the general population, notably in terms of saving time (p = 0.03). However, GPs felt that HP were vulnerable and wanted to protect their patients; they worried about security of data storage. GPs identified specific barriers for HP to use DMP: most of them concerned practical access for HP to DMP (lack of social security card, or lack of tool for accessing internet).A shared electronic health record, such as the French DMP, could improve continuity of care for HP in France. GPs need to be better informed, and DMP functions need to be optimized and adapted to HP, so that it can be effectively used by GPs for HP.

Background Gastrointestinal stromal tumors (GISTs) are rare, but represent the most common mesenchymal neoplasms of the gastrointestinal tract. EPIdemiology GIST, is an observational multicenter longitudinal follow-up cohort study reporting the prescribing patterns of imatinib in patients with GIST and the impact of the treatment in a real-world (standard clinical) setting. Methods Eligible patients had a confirmed diagnosis of unresectable or metastatic KIT-positive GIST and started treatment with imatinib for the first time between May 24, 2002, and June 30, 2010. During routine visits, annual collection of clinical characteristics was requested, i.e., age, GIST stage at diagnosis, history, imatinib treatment duration and dosage, adherence, and concomitant medications. Survival outcomes were estimated using the Kaplan-Meier method. Other data were analyzed using descriptive statistics. Results Of 151 patients enrolled, imatinib was initiated for 126 patients before enrollment and for 25 patients on the day of enrollment or soon after. The patient characteristics were similar to those in published prospective trials. The estimated 1-, 2-, 3-, and 4-year overall survival rates were 90.4% (95% confidence interval [CI; 84.8%-94.0%]), 84.7% (95% CI [78.1%-89.4%]), 73.0% (95% CI [65.0%-79.4%]), and 60.7% (95% CI [51.4%-68.8%]), respectively. The most common adverse events (AEs) were diarrhea (39%), asthenia (39%), eyelid or periorbital edema (32%), abdominal pain (23%), and anemia (21%). Eight of 126 serious AEs were possibly related to the treatment as assessed by investigators. Conclusions Study results showed that patients in real-life populations are generally treated in accordance with national and international clinical recommendations and have outcomes comparable to those of patients in clinical trials.

For older adults, an Emergency Department (ED) visit represents a period of vulnerability that extends beyond the visit itself. This study aimed to determine the impact of the role of caregiver, and geriatric conditions of patients on early unplanned rehospitalization (EUR) within 3 months after an ED visit. This prospective longitudinal experimental study included consecutively 173 patients aged 75 and older admitted in an ED over a 2-week period (18.7 % of the total visits). Only older patients having a caregiver were analyzed (78.0 %, n = 135). Medical conditions and a comprehensive geriatric assessment were recorded for each patient. All caregivers were interviewed about their tasks and emotional impact using the short Zarit Burden Inventory. Three months after, patients or their caregivers were called about the vital status, and EUR of patients. Among the patients included, 64.2 % had an EUR and 28.9 % of their caregivers reported a high level of burden. EUR was strongly associated with a high caregiver burden (OR 8.7, 95 % CI 1.5–49.8). No association was found for patient’s medical or geriatric status. Caregivers reported a significantly high burden when patients were malnourished, or were at risk of adverse health outcomes based on the ISAR scale, and when they had greater disabilities in IADLs and ADLs, or cognitive impairments. Many hospital readmissions after an ED visit may be preventable by identifying caregiver’s high burden. Reasons that lead to this high burden should be checked at the first visit.

International audience

Background This study describes the time trend of renal replacement therapy for end-stage renal disease (ESRD) in the Provence-Alpes Côte d’Azur region (PACA) between 2004 and 2015, and forecasts up to 2030. Methods A longitudinal study was conducted on all ESRD patients treated in PACA and recorded in the French Renal Epidemiology and Information Network (REIN) during this period. Time trends and forecasts to 2030 were analyzed using Poisson regression models. Results Since 2004, the number of new patients has steadily increased by 3.4% per year (95% CI, 2.8–3.9, p

International audience; Objectives: To analyse the views of general practitioners (GPs) about ă how they can provide care to homeless people (HP) and to explore which ă measures could influence their views. ă Design: Mixed-methods design (qualitative -> quantitative ă (cross-sectional observational) -> qualitative). Qualitative data were ă collected through semistructured interviews and through questionnaires ă with closed questions. Quantitative data were analysed with descriptive ă statistical analyses on SPPS; a content analysis was applied on ă qualitative data. ă Setting: Primary care; views of urban GPs working in a deprived area in ă Marseille were explored by questionnaires and/or semistructured ă interview. ă Participants: 19 GPs involved in HP's healthcare were recruited for ă phase 1 (qualitative); for phase 2 (quantitative), 150 GPs who provide ă routine healthcare ('standard' GPs) were randomised, 144 met the ă inclusion criteria and 105 responded to the questionnaire; for phase 3 ă (qualitative), data were explored on 14 `standard' GPs. ă Results: In the quantitative phase, 79% of the 105 GPs already treated ă HP. Most of the difficulties they encountered while treating HP ă concerned social matters (mean level of perceived difficulties=3.95/5, ă IC 95 (3.74 to 4.17)), lack of medical information (mn=3.78/5, IC 95 ă (3.55 to 4.01)) patient's compliance (mn=3.67/5, IC 95 (3.45 to 3.89)), ă loneliness in practice (mn=3.45/5, IC 95 (3.18 to 3.72)) and time ă required for the doctor (mn=3.25, IC 95 (3 to 3.5)). From qualitative ă analysis we understood that maintaining a stable follow-up was a major ă condition for GPs to contribute effectively to the care of HP. Acting on ă health system organisation, developing a medical and psychosocial ă approach with closer relation with social workers and enhancing the ă collaboration between tailored and non-tailored programmes were also ă other key answers. ă Conclusions: If we adapt the conditions of GPs practice, they could ă contribute to the improvement of HP's health. These results will enable ă the construction of a new model of primary care organisation aiming to ă improve access to healthcare for HP.

International audience

To identify independent risk factors of mortality among elderly patients in the 3 months after their visit (T3) to an emergency department (ED).Prospective cohort study.University hospital ED in an urban setting in France.One hundred seventy-three patients aged 75 and older were admitted to the ED over two weeks (18.7% of the 924 ED visits). Of these, 164 patients (94.8%) were included in our study, and 157 (95.7%) of them were followed three months after their ED visit.During the inclusion period (T0), a standardized questionnaire was used to collect data on socio-demographic and environmental characteristics, ED visit circumstances, medical conditions and geriatric assessment including functional and nutritional status. Three months after the ED visits (T3), patients or their caregivers were interviewed to collect data on vital status, and ED return or hospitalization.Among the 157 patients followed at T3, 14.6% had died, 19.9% had repeated ED visits, and 63.1% had been hospitalized. The two independent predictive factors for mortality within the 3 months after ED visit were: malnutrition screened by the Mini Nutritional Assessment short-form (MNA-SF) (OR=20.2; 95% CI: 5.74-71.35; p.001) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score (OR=1.1; 95% CI: 1.01-1.22; p=.024).Malnutrition is the strongest independent risk factor predicting short-term mortality in elderly patients visiting the ED, and it was easily detected by MNA-SF and supported from the ED visit.

Resume Objectif Analyser l’evolution des temps de transport des patients hemodialyses en region Provence-Alpes-Cotes-d’Azur entre 1995 et 2008 au regard de l’evolution de la reglementation concernant l’offre d’hemodialyse. Materiel et methode Les donnees sont issues de trois enquetes transversales pour 1995, 1999 et 2002 incluant l’ensemble des patients dialyses et, pour l’annee 2008 du registre mis en place par le Reseau epidemiologie et information en nephrologie. Les donnees portent sur les caracteristiques sociodemographiques, medicales et sur les temps de transport. Resultats Le nombre de patients hemodialyses augmente, passant de 1807 patients en 1995 a 3141 en 2008. Le temps de transport a diminue regulierement entre 1995 et 2008 (15 minutes versus 18,3 ; p Conclusion L’evolution favorable de l’offre de soins a eu pour consequence une amelioration de l’accessibilite par la diminution des temps de transport.

Background Emergency department (ED) utilization has increased for several decades. ED are becoming busier because of patients with no urgent problems, and their demand for service has resulted in overcrowding in ED. To resolve this problem, primary care units involving general practitioners have been established. The objective of this study is to assess provision of the shift to other health care facilities for no urgent ED patients, starting from entry to ED at the request of the triage nurse. Methods A cross-sectional study was conducted during a one-week period in the adult ED of La Conception Hospital in Marseilles, France. Only no urgent patients identified prospectively by the triage nurse were included. Information was gathered regarding the usual source of care, reason for the visit, care itinerary before presenting to the ED, patient's perception of emergency level, their willingness regarding a reorientation to another health care facility, accomplished actions, and type of discharge. Results Among 245 ED patients, 110 were identified as no urgent by the triage nurse, and 85 effectively answered questions for the purpose of this study. In 76.4% of the cases, the patients were self-referred to ED, however one-third had contacted a physician. The most common reasons provided for attending the ED were pain (55.3%), laboratory and radiographic investigations (37.6%), and difficulty in accessing the usual source of care (22.3%). The mean level of emergency perception was 10.6 ± 5.6 on a zero-twenty scale. Half of the patients presented for traumatology concerns. One-third had an additional examination, six received treatments, and none were hospitalized. Upon entry to ED, more than two-thirds of patients accepted the principle of reorientation to another health care facility. Two main factors linked with this decision were employment status (odds-ratio [OR] = 4.5; 95% confidence interval [CI] = 1.6–12.9) and the perceived emergency level (OR = 0.88; 95% CI = 0.8–0.9). Among patients who refused reorientation, 41 of them were able to pay an additional cost to receive care in the ED. Conclusion Alternative structures such as primary care units near the ED seem to be an appropriate response to meet the growing demand of no urgent patients. The success of providing this reorientation, however, could be determined by the working hours of the structures and the practice of certain technical skills.

The purpose of this study was to determine whether patients have a better level of information about colonoscopy and are more satisfied with medical care when they attend a dedicated consultation with a gastroenterologist prior to the procedure.We conducted a prospective study which compared "exposed" (E) and "non exposed" (NE) patients. In group E, information about colonoscopy was delivered by a gastroenterologist during a special consultation at least 24 hours before the procedure. In group NE, information was delivered in the usual manner. The patients' level of information was measured after colonoscopy and 3 months later.Thirteen patients were included in group E and 18 in group NE. The level of information was better in group E, 5.2 +/- 2.1 versus 3.3 +/- 2.1 (P0.04), as was satisfaction with medical care, 24.9 +/- 4.6 versus 23.0 +/- 5.1 (P0.03). The differences in information levels remained at 3 months.The information delivered during a dedicated precolonoscopy consultation increases assimilation of knowledge concerning the procedure and the patient's satisfaction with medical care.

The evaluation of the professional practices (EPP) is central to the new orientations of French health policies. This evaluation is an essential component of the evaluation process. It aims at increasing the effectiveness and the quality of the health system. Its objective is to help doctors to reflect on their practice, notably in order to engage a continuous improvement process. Contrary to the previous measures taken on this subject, the EPP is common to the whole medical profession (legal obligation). Its method is laid down by decree but the text leaves a free choice as for the method employed. The goal is to accompany doctors in the improvement of their practice by the means of a specific (five years) and continuous evaluation process.

Purpose Little is known about the actual management and treatment of chronic myeloid leukemia (CML) in clinical practice, although there have been many recent changes, such as the introduction of imatinib. Patients and Methods A two-phase cross-sectional observational study with retrospective data collection was conducted in France. In the first phase information regarding health services treating patients with CML was collected. In the second phase, centers caring for 10 or more patients were asked to provide data regarding patients diagnosed with CML that had had a consultation or been hospitalized in the last 3 months. Results All French departments of hematology (n = 218) were contacted by phone. The median number of patients followed per center is 6 (range 0–200). The median number of new patients seen during the last 12 months was 2 (range 0–60). In the second phase 538 patients were included, the sex ratio being 1.14 and median age 55. At the time of diagnosis, 96.8% (n = 519) were in chronic phase, 2.2% (n = 12) in accelerated phase and 0.9% (n = 5) in blastic phase. Eighty-two percent (n = 443) of the patients have been treated by interferon (IFN). Sixteen point 3% (n = 87) of the patients received a bone marrow transplantation (BMT). Forty-six percent (n = 236) of the patients were treated with imatinib. Conclusions This is the first study providing detailed descriptive data concerning the use of medications and procedures in a large population of patients from the medical centers involved in treating CML patients in France. Further observational studies are needed to assess the impact of different treatment strategies and economic impact of CML care in France. Copyright © 2004 John Wiley & Sons, Ltd.

L’objectif de ce travail a ete de recenser, a la date du 30 juin 2003, en France, les differentes maisons medicales de garde (MMG) et d’en decrire les principales caracteristiques. Methodologie : Une enquete telephonique aupres des Unions Regionales des Medecins Liberaux (URML), des Conseils Departementaux de l’Ordre des Medecins (CDOM) et des responsables des MMG a ete menee a partir d’un questionnaire standardise. Resultats : 98 MMG ont ete recensees, 46 sont fonctionnelles et 52 sont en projet. L’Ile-de-France est la region qui concentre le plus de MMG et de projets. La quasi-totalite des MMG ont ete creees apres 2000, la moitie se localise dans des centres de soins, l’autre moitie se divise entre celles proches et celles eloignees des centres de soins. Plus de la moitie des MMG n’ont aucun autre personnel que les medecins, le reste comprend des secretaires, infirmieres, assistantes sociales et autres. Pour plus de la moitie des MMG, les medecins sont payes a l’acte et n’ont pas de plateau technique a disposition. Les MMG sont en general ouvertes la nuit en semaine et le week-end. Un tiers des MMG collabore avec le centre 15 et les trois-quarts sont financees par le Fonds d’Aide a la Qualite des Soins de Ville. Conclusion : Il semblerait souhaitable qu’une charte de fonctionnement des MMG soit etablie afin de standardiser ce type de structures. Par ailleurs, en l’absence de liste exhaustive des MMG, il faudrait qu’un suivi regional et national des MMG soit mis en place, afin de mieux evaluer les evolutions en terme d’organisation sanitaire qu’apportent ces nouvelles structures, a l’echelle des bassins de sante.

Objective:To assess the value of repeated point-prevalence surveys in measuring the trend in nosocomial infections after adjustment for case mix.Setting:A 3,500-bed teaching facility composed of 4 acute care hospitals.Methods:From May 1992 to June 1996, eight point-prevalence surveys of nosocomial infections were performed in the hospitals using a sampling process. The trend of adjusted nosocomial infection rates was studied for the four surveys that collected data on indwelling catheters. Adjusted rates were calculated using a logistic regression model and a direct standardization method.Results:From 1992 to 1996, a total of 20,238 patients were included in the 8 point-prevalence surveys. The nosocomial infection rate decreased from 8.6% in 1992 to 5% in 1996 (P< .001). The analysis of adjusted nosocomial infection rates included 9,600 patients. Four independent risk factors were identified; length of stay greater than 12 days, hospitalization in an intensive care unit, presence of an indwelling urinary catheter, and history of a surgical procedure. After adjustment for case mix, the nosocomial infection rate still showed a downward trend (from 7.2% in 1993 to 5.1% in 1996;P= .02).Conclusion:Adjusted prevalence rates of nosocomial infections showed a significant downward trend during the period of this study.

Objectifs : effectuer une enquete d’opinion aupres des usagers, hors du contexte de l’urgence et en prenant en compte les recours aux soins habituels, caracteriser les populations qui ont eu recours a la demande de soins d’urgence et eclairer les parametres qui influencent cette prise de decision. Methodologie : enquete transversale descriptive aupres d’usagers dans les centres Caisse Primaire d’Assurance Maladie (CPAM) de la zone d’attraction de l’Hopital Nord de Marseille, un jour tire au sort (7 jours au total). Les donnees ont ete recueillies a l’aide d’un questionnaire standardise s’articulant autour des themes suivants : profil socio-demographique des personnes interrogees, comportement des usagers vis-a-vis de la medecine de ville, face a une urgence « ressentie », et ayant eu recours a un service d’urgences. Resultats : l’exploitation des 253 questionnaires remplis montrent que la population est plutot feminine, jeune, defavorisee mais non exclue du systeme de soins (bonne couverture sociale et forte presence d’un medecin de famille).Le comportement des usagers differe selon les heures pendant lesquelles le probleme survient (heures ouvrables ou non ouvrables), selon le degre d’urgence ressenti.La naissance de la demande : dans la majorite des cas, le patient consulte aux urgences pour lui-meme. Il prend lui-meme la decision d’y recourir sans avoir vu de medecin auparavant, dans l’heure qui suit son probleme, qu’il ressent comme tres urgent, voire vital, enfin, il s’y rend par ses propres moyens. La principale raison avancee est l’acces sans rendez-vous au plateau technique. Les principaux motifs medicaux sont les traumatismes et les douleurs. Conclusion : cette etude permet d’observer le fait que l’usager a une demarche coherente en fonction des horaires d’ouverture des cabinets medicaux et en fonction de ce qu’il ressent comme urgent ou non. En outre, il apparait clairement que l’usager manque d’informations sur l’offre de soins dont il dispose et surtout sur le systeme de garde liberal.

Devant l'ampleur des investissements de l'industrie pharmaceutique et les risques financiers encourus par celle-ci, il est important pour les firmes pharmaceutiques de proteger au mieux leurs inventions par de multiples techniques et ce, pendant une longue periode. Les brevets appliques aux molecules sont un moyen de protection temporaire, a ces derniers brevets peuvent s'ajouter des brevets additionnels ou brevets secondaires. Enfin le certificat complementaire de protection constitue aussi un moyen juridique de protection des brevets de medicaments. Une autre methode, exclusive cette fois-ci de reference juridique, permet d'etendre la duree de protection des brevets de medicaments, c'est l'inversion chirale.

Mathematical models currently used to study the relationship between the prevalence of the resistance to an antibiotic and the amount of drug may not be adequate because they do not integrate temporal and area analyses simultaneously. Furthermore, the forms of such relationship are unknown. We applied the Generalized Additive Model (GAM) to study fluoroquinolone use and the incidence of fluoroquinolone-resistance in Staphylococcus aureus in our institution over a 3-year period. Overall institution and individual hospital unitrestricted analyses were performed. Relative risk (RR) observed for increasing fluoroquinolone use with a 4-month lag from the 25th percentile to the 75th percentile was 1.27 (95% CI: 1.13-1.42). In the surgery units, RR was 1.23 (95% CI: 1.01-1.50) for fluoroquinolone use with a 2-months lag. GAM enabled us to observe for the first time a significant temporal relationship between fluoroquinolone use and the incidence of fluoroquinolone-resistant nosocomial S. aureus isolates.

Fatigue has become an important symptom in research and also for clinical diagnosis and follow up. Many physical illnesses, in particular chronic ones such as cancer, are highly associated with fatigue. Various questionnaires for measuring fatigue have been developed, but currently no validated questionnaire exists in French language. We selected the ‘Multidimensional Fatigue Inventory’ (MFI) which has been validated in its English version and then translated into French by the designers. This study describes the validation step of the French version of MFI and presents the psychometric properties of this instrument. A sample of 225 patients was divided into three groups ‘Tired’ (82 subjects), ‘Moderately tired’ (36) and ‘Not tired’ (107). The analysis of the structure validity found four dimensions: ‘General Fatigue’, ‘Mental Fatigue’, ‘Reduced Activities’ and ‘Motivation’. The convergent validity showed highly significant correlation (P 0.70. The reproducibility and sensitivity to change in patients who were followed up one month later show satisfactory results. This validation study of the French version of MFI shows that this instrument is valid for clinical application and allows different dimensions of fatigue to be assessed which is of particular interest for physicians, especially for cancer carers, where fatigue assessment is an important aspect of the follow up.

RESUME Le Haut Comite de la sante publique est remplace dans la loi du 4 mars 2002 par le Haut Conseil de la sante. Pendant ses dix annees d’activite, il a repondu a sa mission d’orienter la politique de sante a travers deux types de rapports. Les rapports triennaux (1994, 1998, 2002) ont dresse l’etat de sante de la France, montrant ses forces et ses faiblesses, proposant une analyse critique du systeme de sante. Les rapports thematiques etablis sur saisine du ministre ont oriente un grand nombre de textes reglementaires dans des domaines touchant a l’organisation des soins ou a la prevention. Au-dela de ces missions, la production du HCSP a egalement eu pour effet de diffuser la culture et les methodes de sante publique, dont la place en France demeure encore trop marginale.

Les phases de sensibilisation et de formation sont des pre-requis majeurs pour s’assurer de la comprehension des enjeux de l’accreditation. Aucune etude n’a ete publiee sur la facon de mener a bien cette sensibilisation. Cette etude a pour objectifs, de mesurer l’efficacite de la phase de sensibilisation et d’elaborer des recommandations generales pour orienter les etablissements de sante dans leur politique de communication. Une etude transversale basee sur un questionnaire a ete menee aupres de 107 professionnels de 23 services cliniques tires au sort au sein de l’Assistance Publique-Hopitaux de Marseille. Les resultats montrent que les connaissances sur l’accreditation semblent bien integrees, seules 7 des personnes ignorent l’existence de la procedure d’accreditation, 58 % l’associent a une procedure d’autorisation. Les resultats varient peu selon la categorie de personnel. Le niveau de connaissance global est meilleur chez les personnes formees (p < 0,05), mais il existe une meconnaissance de l’organisation des structures internes mises en place. La communication sur l’accreditation est jugee insuffisante par les trois quarts des personnes. Cet etat des lieux confirme les benefices qu’apportent les actions de communication et permet d’identifier un certain nombre d’ecueils a eviter. Plusieurs recommandations sont proposees.

Objective To investigate the impact of social inequalities on the risk of rehospitalization in the first year after discharge from the neonatal unit in a population of preterm-born children. Study design Preterm infants were included if they were born between 2006 and 2013 at ≤32 + 6 weeks of gestation and who received follow-up in a French regional medical network with a high level of healthcare. Socioeconomic context was estimated using a neighborhood-based socioeconomic deprivation index. Univariate and logistic regression analyses were used to identify risk factors associated with rehospitalization. Results For the 2325 children, the mean gestational age was 29 ± 2 weeks and the mean birth weight was 1315 ± 395 g. In the first year, 22% were rehospitalized (n = 589); respiratory diseases were the primary cause (44%). The multiple rehospitalization rate was 18%. Multivariable analysis showed that living in the most deprived neighborhoods (socioeconomic deprivation index of 5) was associated with overall rehospitalization (OR, 2.2; 95% CI, 1.5-3.6; P .001), and multiple rehospitalizations (OR, 2.5; 95% CI, 1.2-4.9; P .01); with socioeconomic deprivation index of 1 (least deprived) as reference. Deprivation was associated with all causes of hospitalization. Female sex ( P .001) and living in an urban area ( P = .001) were protective factors. Conclusions Despite regional routine follow-up for all children, rehospitalization after very preterm birth was higher for children living in deprived neighborhoods. Families' social circumstances need to be considered when evaluating the health consequences of very preterm birth.

Objective:To determine the role of nonmedicated soap as a source ofSerratia marcescensnosocomial infections (NIs) in hospital units with endemicS marcescensNI and to examine the mechanisms of soap colonization.Setting:University-affiliated tertiary-care hospitals.Methods:A prospective case-control study and an environmental investigation were performed to assess the relationship betweenS marcescensNIs in hospital units andS marcescens-contaminated soap. Soap-bottle use and handwashing practices were reviewed. Cultures of healthcare workers’ (HCWs) hands were obtained before and after hand washing with soap.Results:5 of 7 hospital units withS marcescensNIs had soap bottles contaminated withS marcescens, compared to 1 of 14 other units (P=.006). After hand washing with anS marcescens-contaminated soap pump, HCWs' hands were 54 times more likely to be contaminated withS marcescens(PConclusions:Extrinsic contamination of a non-medicated liquid soap byS marcescensresulted in handborne transmission ofS marcescensNIs by HCWs in our setting. This finding led to the application of strict guidelines for nonmedicated soap use and to the reinforcement of alcoholic hand disinfection.

Resume La mise en place du Guide de bonne exeution des analyses (GBEA) dans un etablissement public releve de la responsabilite partagee des biologistes et de l'administration. La demarche entreprise au sein de l'Assistance Publique Hopitaux de Marseille (AP-HM) a consister a federer, autour d'un systeme qualite unique dans sa conceptualisation, l'ensemble des efforts fournis par les 35 laboratoires de l'etablissement. Cet objectif d'harmonisation a necessite la creation d'un Comite de pilotage, l'elaboration d'un calendrier d'actions, l'encadrement methodologique de la demarche par un Comite d'execution et l'engagement formel des laboratoires garantissant la reussite du projet au terme des delais fixes. L'engagement de la Direction s'est traduit par sa participation a l'elaboration de procedures relevant de son domaine de competence directe (archives, maintenance, commandes, marches, etc.). La demarche au sein de l'AP-HM, commencee en juin 1997, devrait s'achever, conformement au calendrier d'action prevu, en janvier 1999. Au terme d'un an, l'etat d'avancement de la demarche est positif avec 13 des 17 procedures generales redigees par l'ensemble des laboratoires. Les principales difficultes recontrees relevant de facteurs humains, de contraintes liees aux principes de l'assurance qualite: surcharge de travail a moyens constants, passage d'une culture orale a une culture ecrite. La mobilisation des biologistes est tres encourageante, temoin d'une evolution culturelle integrant les concepts d'assurance qualite. La perennisation du systeme qualite necessite cependant que cet effort soit soutenu a long terme et que les dysfonctionnements qui ont ete identifies tout au long de la demarche soit corriges.

1. A statistically significant increased risk of schizophrenia for individuals born in winter has been reported. The increase risk is of the order of 5-15 percent. The seasonal effect is more marked among females. This winter birth effect suggests some environmental agents, probably a neuropathogen one, acting on the foetus. 2. The present study sought to test the environmental damage hypothesis by application of the family history of psychiatric disorder distinction to season of birth data divided according to sex and using a control population. 3. From computer records, all patients admitted to the psychiatric department of Marseilles Timone hospital between January 1984 and December 1989 who satisfied DSM III, DSM III R criteria for schizophrenia were identified. Patients were then classified into two groups: family history of psychiatric disorder versus no family history. Division according to the sex was carried on after two groups were formed. 4. The data show (I) a significant excess of births in the early months of the year (p0.05) for all patients with no family history of psychiatric disorder, (2) a significant excess of births for females (p0.05) with no family history. 5. These results provide indirect support for the neurodevelopmental theory of schizophrenia.

La Presse Medicale - In Press.Proof corrected by the author Available online since mercredi 29 juin 2016

In 1992, we conducted two prevalence surveys on hospital-acquired infections (HAIs) in a group of eight university affiliated hospitals with a total of 4462 acute care beds. Most of the intensive care units (ICUs) already had a prospective surveillance scheme. The need for HAI rates that could be estimated easily and economically led us to develop a prevalence survey by using a stratified sampling method. The units were distributed into four groups: ICU; clean surgery; other surgery; and medical. In each group a sample of units was randomly selected using different sampling fractions. The first survey was conducted in May and involved 1220 patients. The second survey in November included 1389 patients. The HAI rates in May and November were 8·6% (95% CI 7·4–9·8%) and 7·1% (95% CI 6–8·2%), respectively. This study allowed us to direct resources towards high risk units and clean surgical procedures. Based on the results, prospective surveillance was implemented in units of the clean surgery group.

Resume En 1992, deux enquetes de prevalence sur les infections nosocomiales ont ete realisees par une methode de sondage sur l'Assistance Publique de Marseille, une structure hospitaliere regroupant 4000 lits de court sejour. Les enquetes ont porte respectivement sur 42 % et 50 % des patients hospitalises. Le taux d'infections acquises a l'APM etait de 8,6 % et 7,1 % avec une precision de 1,2 % et 1,1 %. Cette etude a montre la faisabilite de ce type d'enquete et a permis une utilisation efficace des ressources pour etudier les services a haut risque d'infections. A partir des resultats obtenus une surveillance prospective a ete developpee dans certains services de soins intensifs et de chirurgie, pour completer le systeme de surveillance en incidence deja en place dans la majorite des services de reanimation.

A consensus conference on the topic of clinical drug trials in cognitive disorders of the elderly was held in Marseille on January 28–29, 1993. At the end of this conference, several recommendations were made. Drugs used in trials must be chosen according to solid neurobiological evidence. Clinical trials profoundly alter the relations between the doctor, the patient and his family and this aspect must be taken into account. Clinical trials should be designed to obtain meaningful and useful data in the domains of pharmacology and epidemiology. Patient selection criteria must be defined with strict attention to the nosology of syndromes causing cognitive disorders in the elderly. Objective evaluation tests able to detect subtle drug effects must be carefully chosen according to the requirements of each trial. Whenever possible, laboratory tests should be used in addition to clinical data. The ethical implications of clinical trials in demented patients require special adaptation to satisfy legal requirements.

Background For several decades, emergency departments (EDs) utilization has increased, inducing ED overcrowding in many countries. This phenomenon is related partly to an excessive number of nonurgent patients. To resolve ED overcrowding and to decrease nonurgent visits, the most common solution has been to triage the ED patients to identify potentially nonurgent patients, i.e. which could have been dealt with by general practitioner. The objective of this study was to measure agreement among ED health professionals on the urgency of an ED visit, and to determine if the level of agreement is consistent among different sub-groups based on following explicit criteria: age, medical status, type of referral to the ED, investigations performed in the ED, and the discharge from the ED. Methods We conducted a multicentric cross-sectional study to compare agreement between nurses and physicians on categorization of ED visits into urgent or nonurgent. Subgroups stratified by criteria characterizing the ED visit were analyzed in relation to the outcome of the visit. Results Of 1,928 ED patients, 350 were excluded because data were lacking. The overall nurse-physician agreement on categorization was moderate (kappa = 0.43). The levels of agreement within all subgroups were variable and low. The highest agreement concerned three subgroups of complaints: cranial injury (kappa = 0.61), gynaecological (kappa = 0.66) and toxicology complaints (kappa = 1.00). The lowest agreement concerned two subgroups: urinary-nephrology (kappa = 0.09) and hospitalization (kappa = 0.20). When categorization of ED visits into urgent or nonurgent cases was compared to hospitalization, ED physicians had higher sensitivity and specificity than nurses (respectively 94.9% versus 89.5%, and 43.1% versus 30.9%). Conclusions The lack of physician-nurse agreement and the inability to predict hospitalization have important implications for patient safety. When urgency screening is used to determine treatment priority, disagreement might not matter because all patients in the ED are seen and treated. But using assessments as the basis for refusal of care to potential nonurgent patients raises legal, ethical, and safety issues. Managed care organizations should be cautious when applying such criteria to restrict access to EDs.

We analysed the trend of travel-times for haemodialysis patients in the Provence-Alpes-Côte-d'Azur region between 1995 and 2008 in relation with the reforms concerning the health care provision of haemodialysis.We conducted this study using data from three cross sectional surveys for 1995, 1999 and 2002, including all dialysis patients, and from the Renal Epidemiology and Information Network register for 2008. The data focuses on sociodemographic, medical characteristics and travel-times for haemodialysis patients.The number of haemodialysis patients increased from 1807 patients in 1995 to 3141 in 2008. The travel-time has decreased steadily between 1995 and 2008 (18.2 min versus 15, P0.0001). The number of patients with a travel-time more than 45 min decreased from 7.2 to 3.5% between 1995 and 2008. The number of dialysis facilities has increased steadily between 1995 and 2008.The favorable trend in the health care provision has resulted in an improvement of accessibility by reducing travel-times.

OBJECTIVES: To assess the impact of continuous incident reporting and subsequent prevention strategies on the incidence of severe iatrogenic events and targeted priorities in admitted neonates. METHODS: We performed preintervention (January 1 to September 1, 2005) and postintervention (January 1, 2008, to January 1, 2009) prospective investigations based on continuous incident reporting. Patient-safety initiatives were implemented for a period of 2 years. The main outcome was a reduction in the incidence of severe iatrogenic events. Secondary outcomes were improvements in 5 targeted priorities: catheter-related infections; invasive procedures; unplanned extubations; 10-fold drug infusion-rate errors; and severe cutaneous injuries. RESULTS: The first and second study periods included totals of 388 and 645 patients (median gestational ages: 34 and 35 weeks, respectively; P = .015). In the second period the incidence of severe iatrogenic events was significantly reduced from 7.6 to 4.8 per 1000 patient-days (P = .005). Infections related to central catheters decreased significantly from 13.9 to 8.2 per 1000 catheter-days (P < .0001), as did exposure to central catheters, which decreased from 359 to 239 days per 1000 patient-days (P < .0001). Tenfold drug-dosing errors were reduced significantly (P = .022). However, the number of unplanned extubations increased significantly from 5.6 to 15.5 per 1000 ventilation-days (P = .03). CONCLUSIONS: Prospective, continuous incident reporting followed by the implementation of prevention strategies are complementary procedures that constitute an effective system to improve the quality of care and patient safety.

Nonurgent visits to emergency departments (ED) are a controversial issue; they have been negatively associated with crowding and costs. We have conducted a critical review of the literature regarding methods for categorizing ED visits into urgent or nonurgent and analyzed the proportions of nonurgent ED visits. We found 51 methods of categorization. Seventeen categorizations conducted prospectively in triage areas were based on somatic complaint and/or vital sign collection. Categorizations conducted retrospectively (n = 34) were based on the diagnosis, the results of tests obtained during the ED visit, and hospital admission. The proportions of nonurgent ED visits varied considerably: 4.8% to 90%, with a median of 32%. Comparisons of methods of categorization in the same population showed variability in levels of agreement. Our review has highlighted the lack of reliability and reproducibility.

We assessed the ability of a standard disinfection procedure to eliminate hepatitis C virus (HCV) from the air-water channel of hysteroscopes. The residual HCV RNA remaining after the disinfection procedure was measured by polymerase chain reaction. When correctly applied to hysteroscopes, the standard disinfection procedure was sufficient to eliminate the risk of HCV transmission.

The evaluation of the professional practices (EPP) is central to the new orientations of French health policies. This evaluation is an essential component of the evaluation process. It aims at increasing the effectiveness and the quality of the health system. Its objective is to help doctors to reflect on their practice, notably in order to engage a continuous improvement process. Contrary to the previous measures taken on this subject, the EPP is common to the whole medical profession (legal obligation). Its method is laid down by decree but the text leaves a free choice as for the method employed. The goal is to accompany doctors in the improvement of their practice by the means of a specific (five years) and continuous evaluation process.

Announcement of cancer diagnosis and first contact with medical team in charge of treatment is critical for the patient as well as for the quality of care. The French Cancer Plan include a special focus on these announcement which should be performed in adequate conditions and which should include the presentation of a personalised treatment plan, that reflect multidisciplinary discussion and decision performed before. In order to generalized a formal announcement consultation all over the country in 2005, an experimentation has been performed in 58 centers grouped in 37 projects. Neuro-Oncology Unit of the Assistance Publique-Hopitaux de Marseille did participate to that experimentation. Evaluation of these experiment focus on physician, nurse, and patient perception as well as cost impact and exploration of language during that particular time. Implication of a referent nurse in that time was a strong option of our center. We analyzed the result in 80 patients referred in our center for initial diagnosis (78%) or announcement of recurrence (14%) in a 5 months time. Implication of the nurse appear to be critical for patient confidence and accessibility to information for the all medical team. Organization of a particular time devoted to cancer announcement appear to have a favourable impact on quality of care and patient perception, and constitute a first step to a personalized management of patients with cancer.