Quality strategies: what are French universities looking for?

Using steps transposed from corporate quality strategies, French universities have entered a new stage of their modernization, illustrative of the current of New Public Management. These strategies, destined to combine missions of excellence and the transformation of thousands of young people into graduates, will be studied here with regard to different horizons which they suggest for French higher education. In change for the last 40 years, called into question over its costs, its production, and its management, university is at the crossroads of autonomy, clientelism and professionalisation. Our system of higher education must now combine savings, realignment, local governorship, partnerships and a geographical distribution of training opportunities, within the new European arena of degrees. However, it suffers from several handicaps (at once fiscal, legislative, administrative and social) aggravated by a specifically French fracture: how then can the quality strategies put in place, bring about the efficiency coveted by higher education ? This higher education system demonstrates several innovations and have begun to make surveys of the employability levels of its graduates. Thus, benchmarking is available on the condition that the criteria and indicators of the performance comparison are reached by consensus, and that's not the case: is it political arbitration (that rules over university as a public service) or market arbitration which determines the value of degrees? calibration and measurement could not be the same: who decides? which path opens to university to come out this dilemma?efficiency, French higher education, Lisbon strategy, NMP, quality, standards.

Indicateurs et benchmarks

Pour la plupart pluriséculaires, puisqu'elles s'originent au coeur du Moyen-âge français chrétien[1], les universités ont été structurée dans leurs cinq contours modernes que voici, par décret[2] d'empire napoléonien: 1 la laïcité, "lieu exclusif d'enseignement... aucune école, aucun établissement quelconque d'instruction ne peut être formé en dehors de l'université impériale" ; 1 les champs disciplinaires, "cinq ordres de faculté (théologie, droit, médecine, sciences mathématiques et physiques, lettres" ; 1 le mode hiérarchique, "un doyen choisi parmi les professeurs à  la tête de chaque faculté de théologie" ; 1 la production, "chaque faculté confêre trois grades (baccalauréat, licence, doctorat) à  la suite d'examens et actes publics" ; 1 le zonage académique, "autant qu'il y a de cours d'appel". Toujours digne représentante du service public français "hybride"[3] (Demeestêre, Orange, 2008), l'université est aujourd'hui comptable de ses résultats, i.e. du service rendu aux citoyens et non plus seulement de l'historique obligation de moyens. La derniêre décennie a été féconde en repositionnements et transformations: nous proposons de les rappeler sommairement avant d'en discuter les actuelles incidences stratégiques.   [1] Sorbonne créée en 1215 pour former des prêtres [2] Décret impérial N°3179 portant organisation de l'Université, Bulletin des Lois N°185, Palais des Tuileries, 17 mars 1808 [3] Mi-décentralisé, mi-déconcentré selon les auteurs, dans un contexte d'inter-ministérialité depuis 2004 (SGAR, PASE

Characteristics and outcome of prostate cancer with PSA <4 ng/ml at diagnosis: a population-based study

Introduction: This population-based study aims to assess prognosis of prostate cancer diagnosed with prostate-specific antigen (PSA) levels <4 ng/ml in routine care. Materials and methods: We compared prostate cancer patients with low PSA values (n=59) with other prostate cancer patients (n=1330) by logistic regression and the Cox model using data from the Geneva Cancer Registry. Results: Patients with low PSA values more frequently had early-stage and well differentiated tumours. Nevertheless, 35% presented with aggressive tumour characteristics or metastases. After adjustment for other prognostic factors, prostate cancer-specific mortality was similar for both groups (hazard ratio: 1.1; 95%CI: 0.6-2.2). Conclusion: We conclude that cancer with low PSA values at diagnosis is not indolen

Erratum to: Chest physiotherapy using passive expiratory techniques does not reduce bronchiolitis severity: a randomised controlled trial

Chest physiotherapy (CP) using passive expiratory manoeuvres is widely used in Western Europe for the treatment of bronchiolitis, despite lacking evidence for its efficacy. We undertook an open randomised trial to evaluate the effectiveness of CP in infants hospitalised for bronchiolitis by comparing the time to clinical stability, the daily improvement of a severity score and the occurrence of complications between patients with and without CP. Children <1year admitted for bronchiolitis in a tertiary hospital during two consecutive respiratory syncytial virus seasons were randomised to group 1 with CP (prolonged slow expiratory technique, slow accelerated expiratory flow, rarely induced cough) or group 2 without CP. All children received standard care (rhinopharyngeal suctioning, minimal handling, oxygen for saturation ≥92%, fractionated meals). Ninety-nine eligible children (mean age, 3.9months), 50 in group 1 and 49 in group 2, with similar baseline variables and clinical severity at admission. Time to clinical stability, assessed as primary outcome, was similar for both groups (2.9 ± 2.1 vs. 3.2 ± 2.8days, P = 0.45). The rate of improvement of a clinical and respiratory score, defined as secondary outcome, only showed a slightly faster improvement of the respiratory score in the intervention group when including stethoacoustic properties (P = 0.044). Complications were rare but occurred more frequently, although not significantly (P = 0.21), in the control arm. In conclusion, this study shows the absence of effectiveness of CP using passive expiratory techniques in infants hospitalised for bronchiolitis. It seems justified to recommend against the routine use of CP in these patient

Chest physiotherapy using passive expiratory techniques does not reduce bronchiolitis severity: a randomised controlled trial

Chest physiotherapy (CP) using passive expiratory manoeuvres is widely used in Western Europe for the treatment of bronchiolitis, despite lacking evidence for its efficacy. We undertook an open randomised trial to evaluate the effectiveness of CP in infants hospitalised for bronchiolitis by comparing the time to clinical stability, the daily improvement of a severity score and the occurrence of complications between patients with and without CP. Children <1year admitted for bronchiolitis in a tertiary hospital during two consecutive respiratory syncytial virus seasons were randomised to group 1 with CP (prolonged slow expiratory technique, slow accelerated expiratory flow, rarely induced cough) or group 2 without CP. All children received standard care (rhinopharyngeal suctioning, minimal handling, oxygen for saturation ≥92%, fractionated meals). Ninety-nine eligible children (mean age, 3.9months), 50 in group 1 and 49 in group 2, with similar baseline variables and clinical severity at admission. Time to clinical stability, assessed as primary outcome, was similar for both groups (2.9 ± 2.1 vs. 3.2 ± 2.8days, P = 0.45). The rate of improvement of a clinical and respiratory score, defined as secondary outcome, only showed a slightly faster improvement of the respiratory score in the intervention group when including stethoacoustic properties (P = 0.044). Complications were rare but occurred more frequently, although not significantly (P = 0.21), in the control arm. In conclusion, this study shows the absence of effectiveness of CP using passive expiratory techniques in infants hospitalised for bronchiolitis. It seems justified to recommend against the routine use of CP in these patient

Risk of second breast cancer according to estrogen receptor status and family history

A recent study reported an increased risk of contralateral estrogen-negative breast cancer after a first primary estrogen-negative breast cancer. Our study aims to confirm this result and to evaluate how the risk of second breast cancer occurrence is affected by family history of breast cancer and anti-estrogen treatment. We included all 4,152 women diagnosed with breast cancer between 1995 and 2007, using data from the population-based Geneva Cancer Registry. We compared the incidence of second breast cancer among patients according to estrogen receptor (ER) status with that expected in the general population by age-period Standardized Incidence Ratios (SIRs). Among the cohort, 63 women developed second breast cancer. Patients with ER-positive first tumors had a decreased risk of second breast cancer occurrence (SIR: 0.67, 95% CI: 0.48-0.90), whereas patients with ER-negative primary tumors had an increased risk (SIR: 1.98, 95% CI: 1.19-3.09) limited to ER-negative second tumors (SIR: 7.94, 95% CI: 3.81-14.60). Patients with positive family history had a tenfold (SIR: 9.74, 95% CI: 3.57-21.12) higher risk of ER-negative second tumor which increased to nearly 50-fold (SIR: 46.18, 95% CI: 12.58-118.22) when the first tumor was ER-negative. Treatment with anti-estrogen decreased the risk of second ER-positive tumors but not ER-negative tumors. The risk of second ER-negative breast cancer is very high after a first ER-negative tumor, in particular among women with strong family history. Surveillance and prevention of second cancer occurrence should consider both ER status of the first tumor and family histor

Changing pattern of age-specific breast cancer incidence in the Swiss canton of Geneva

Hormone replacement therapy (HRT) use declined sharply after mid-2002, when the Women's Health Initiative trial reported an association between breast cancer occurrence and HRT. Hypothesized mechanism behind this association is that HRT promotes growth of pre-existing small tumors, leading to earlier tumor detection. We evaluated the impact of the sudden decline in HRT use on age distribution of breast cancer in Geneva. We included all incident breast cancer cases recorded from 1975 to 2006 at the Geneva cancer registry. We calculated mean annual incidence rates per 100,000 for 2year periods for three age groups and assessed temporal changes by joinpoint regression. We compared age-specific incidence curves for different periods, reflecting different prevalence rates of HRT use. After increasing constantly between 1986 and 2002 among women aged 50-69years [annual percent change (APC): +4.4, P<0.0001], rates declined sharply after 2003 (APC: −6.0; P=0.0264). Age-specific breast cancer rates changed dramatically with changes in prevalence of HRT use. During low HRT prevalence, breast cancer incidence increased progressively with age, when HRT prevalence was reaching its maximum (1995-2002), higher rates were seen in 60- to 64-year-old women, with a concomitant decrease in risk among elderly. After the sudden decline in HRT use, the incidence peak diminished significantly and incidence increased again with age. Following the abrupt decline in HRT use in Geneva, breast cancer incidence rates among post-menopausal women decreased considerably with striking changes in age-specific incidence rates before, during and after the peak in HRT prevalenc

Impact of obesity on diagnosis and treatment of breast cancer

In this population-based study, we evaluated the impact of obesity on presentation, diagnosis and treatment of breast cancer. Among all women diagnosed with invasive breast cancer in the canton Geneva (Switzerland) between 2003 and 2005, we identified those with information on body mass index (BMI) and categorized them into normal/underweight (BMI <25kg/m2), overweight (BMI ≥-<30kg/m2) and obese (BMI ≥30kg/m2) women. Using multivariate logistic regression, we compared tumour, diagnosis and treatment characteristics between groups. Obese women presented significantly more often with stage III-IV disease (adjusted odds ratio [ORadj]: 1.8, 95% CI: 1.0-3.3). Tumours ≥1cm and pN2-N3 lymph nodes were significantly more often impalpable in obese than in normal/underweight patients (ORadj 2.4, [1.1-5.3] and ORadj 5.1, [1.0-25.4], respectively). Obese women were less likely to have undergone ultrasound (ORadj 0.5, [0.3-0.9]) and MRI (ORadj 0.3, [0.1-0.6]) and were at increased risk of prolonged hospital stay (ORadj 4.7, [2.0-10.9]). This study finds important diagnostic and therapeutic differences between obese and lean women, which may impair survival of obese women with breast cancer. Specific strategies are needed to optimize the care of obese women with or at risk of breast cance

The impact of socioeconomic position on stage at diagnosis and survival in colorectal cancer patients in Switzerland

Studies outside of Switzerland have reported socioeconomic inequalities in colorectal cancer (CRC) stage at diagnosis and survival. Aim : To investigate the impact of socioeconomic position (SEP) and further demographic characteristics on colorectal cancer (CRC) stage at diagnosis on CRC-specific survival ; To investigate whether potential survival inequalities can be explained by differences in stage at diagnosis and/or sociodemographic factors

The relative risk of second primary cancers in Switzerland

This study aims to investigate the relative risk of SPCs in cancer survivors in Switzerland combining data from all Swiss cantonal cancer registries with at least 15 years of consecutive incidence data