Implementation of a top five list to identify medical overuse in general practice according to patients’ viewpoint in 2019 in France

International audienceBackground: There is a current trend to reassess the adequacy of care. Establishing top five lists by involving patients is one way to address medical overuse. The objective of this study was to establish a patients' top five list in general practice in France. The secondary objective was to identify selection criteria.Method: Patients from the web-based cohort GrippeNet.fr were invited to establish their top five list from 15 care procedures previously selected by general practitioners on the basis of medical overuse. The care procedures were presented on a web-interface with guides written with the help of a patient association. A questionnaire was used to explore factors that may have influenced the choices of the participants.Results: In total, 691 patients established the following top five list: 1/ Prescription of antibiotics for acute bronchitis, nasopharyngitis, otitis media with effusion, or uncomplicated influenza; 2/ Prescription of benzodiazepine and benzodiazepine-like agents for insomnia, generalised anxiety and all indications for older patients; 3/ Prescription of a homeopathic treatment (Influenzinum) for flu prevention; 4/ Prescription of antitussive or expectorant agents for acute cough or acute bronchitis care; 5/ Prescription of statins for the primary prevention of cardio-vascular risk in older patients. More than 70% of participants gave importance to the recommendations, effectiveness, and tolerance of the care procedures, whereas only half considered the cost.Conclusion: This study is the first to establish a patient's top-five list in general practice. This list provides direction for deciding the main targets in limiting medical overuse

A top 5 list for French general practice

International audienceBackground: Medical overuse is an issue that has recently gained attention. The "Choosing Wisely" campaign invited each specialty in each country to create its own top five lists of care procedures with a negative benefit-risk balance to promote dialogue between patients and physicians. This study aims to create such a list for French general practice.Methods: A panel of general practitioners (GPs) suggested care procedures that they felt ought to be prescribed less. Using the Delphi method, a short list of those suggestions was selected. Systematic literature reviews were performed for each item on the short list. The results were presented to the panel to assist with the final selection of the top five list.Results: The panel included 40 GPs. The list includes: i/ antibiotics prescription for acute bronchitis, nasopharyngitis, otitis media with effusion, or uncomplicated influenza, ii/ systematic prostate specific antigen testing in men older than 50, iii/ prescription of cholinesterase inhibitors for mild cognitive impairment and for Alzheimer's disease and memantine for Alzheimer's disease, iv/ statins prescription in primary prevention of cardio-vascular risk in older patients, and v/ benzodiazepine or benzodiazepine-like agents prescription for generalised anxiety, insomnia, and for all indications in older patients.Conclusions: This study resulted in a French top five list in general practice using a panel of GPs. All the items selected have a negative risk-benefit balance and are frequently prescribed by French general practitioners. This list differs from other top five lists for general practice, reflecting the local medical culture

Caractérisation des environnements de production et de nouveaux phénotypes pour améliorer la sélection et l’adaptation des ovins et caprins dans des environnements variés

The overall sustainability and innovative capacity of the sheep and goat sector in Europe have to be improved to cope with current and future economic, environmental and societal challenges. Innovations in genetic resource management and breeding for sheep and goat populations will be explored in the iSAGE European project (WP5) in order to help the industry to cope with such future challenges. In France, genetic evaluation for small ruminants is performed in a large variability and poorly characterized environments. In this regard, we will consider multi-generation data from existing French breeding programs and experimental field studies. Effects of herd for traits under genetic selection will be investigated in commercial farms in order to better characterize the production environment, particularly using meteorological data but also feeding, breeding system and economic criteria. Such characterization will enable to follow-up trends in animal performances according to weather changes. This work could also contribute to characterize farm typologies to which a set of sustainability indicators will be tested. Then, contrasted environments will be identified and genotype by environment interactions studies will be carried out aiming to improve genetic selection efficiency in a variety of environments. In addition to existing data, we will explore new phenotypes considered as key functional traits for robustness and for which stakeholders are particularly interested. These new phenotypes will be also explored in combination with feed efficiency in experimental facilities under contrasted environments or under feed shortage challenges. Genetic and genomic studies will be performed for new phenotypes used to assess individual robustness. The total merit indices will be revisited from the technical and economic point of view in order to evaluate economic weights of each trait in the "breeding goal", for diversified production systems.En France, l’évaluation génétique des petits ruminants estime simultanément la valeur génétique des reproducteurs ainsi que les effets d’environnement dont le plus important est l’effet troupeau. Cette évaluation est réalisée dans des environnements variés et mal caractérisés faisant l’hypothèse d’absence d’interaction GxE. Pour tester cette hypothèse et disséquer les composantes des effets troupeaux, les environnements de production seront caractérisés à partir des données collectées en fermes (disponibles dans les systèmes nationaux d’information génétique ou collectées ponctuellement) décrivant les systèmes d’élevages et des données météorologiques. La discrimination des types d’environnements de production établis par la typologie des élevages permettra d’analyser les interactions GxE pour différentes races ovines et caprines en France.Par ailleurs, l’adaptation des petits ruminants à ces environnements variés et changeants implique entre autre leur efficacité d’utilisation des ressources et leur capacité biologique à mobiliser et reconstituer leurs réserves énergétiques sous forme de lipides. Des travaux expérimentaux seront conduits pour étudier les mécanismes biologiques et le déterminisme génétique de la dynamique des réserves corporelles en lien avec l’efficacité alimentaire. Cette approche permettra d’identifier de nouveaux phénotypes pour l’amélioration génétique de la robustesse des petits ruminants