Les logiciels de gestion de cabinet de médecine générale (utilisations, besoins et critiques)

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Validation of a Navier-Stokes code using A \#kappa#, #epsilon#\ turbulence model applied to a three-dimensional transonic channel

Tire de : AIAA 31st Aerospace Sciences Meeting and Exhibit, Reno, NV (USA), January 11-14, 1993SIGLEAvailable at INIST (FR), Document Supply Service, under shelf-number : 22419, issue : a.1993 n.3 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Benchmarking patient experiences in colonoscopy using the Global Rating Scale

Introduction: The Global Rating Scale (GRS) is a quality assurance program that was developed in England to assess patient-centered care in endoscopy. The aim of the current study was to evaluate patient experiences of colonoscopy using the GRS in order to compare different departments and to provide benchmarks. The study also evaluated factors associated with patient satisfaction. Methods: A GRS questionnaire was used both before and after the procedure in outpatients undergoing colonoscopy. The questionnaire assessed the processes associated with the colonoscopy, from making the appointment up until discharge. Mean values and ranges of 12 endoscopy departments were calculated together with P values in order to assess heterogeneity. Results: In total, 1904 pre-procedure and 1532 (80%) post-procedure questionnaires were returned from 12 endoscopy departments. The mean time patients had to wait for their procedure was 4.3 weeks (range 3.1-5.8 weeks), and 54% (range 35-64%; P < 0.001) reported being given a choice of appointment dates/times. Discomfort during colonoscopy was reported by 20% (range 8-40%; P < 0.001). Recovery room privacy was satisfactory for 76% of patients (range 66-90%; P < 0.05). The majority of patients re Conclusion: Overall patient experiences with colonoscopy were satisfactory, but they also showed considerable variation. This study shows that use of a GRS patient questionnaire is feasible in the Dutch endoscopy setting for the assessment of patient experience. The significant variability between endoscopy units can be used to benchmark services and enable shortcomings to be identified

Quality evaluation of colonoscopy reporting and colonoscopy performance in daily clinical practice

Background: Comprehensive monitoring of colonoscopy quality requires complete and accurate colonoscopy reporting. Objective: This study aimed to assess the compliance with colonoscopy reporting and to assess the quality of colonoscopy performance. Design: Consecutive colonoscopy reports were reviewed by hand. Four hundred reports were included from each department. Setting: Daily clinical practice in 12 Dutch endoscopy departments. Patients: Consecutive patients undergoing scheduled colonoscopy procedures. Main Outcome Measurements: Quality of reporting was assessed by using the American Society for Gastrointestinal Endoscopy criteria for colonoscopy reporting. Quality of colonoscopy performance was evaluated by using the cecal intubation rate and adenoma detection rate (ADR). Results: A total of 4800 colonoscopies were performed by 116 endoscopists: 70% by gastroenterologists, 16% by gastroenterology fellows, 10% by internists, 3% by nurse-endoscopists, and 1% by surgeons. The mean age of the patients was 59 years (standard deviation 16), and 47% were male. Reports contained information on indication, sedation practice, and extent of the procedure in more than 90%. Only 62% of the reports mentioned the quality of bowel preparation (range between departments 7%-100%); Limitations: Dependent on reports, no intervention in endoscopic practice. No analysis for performance per endoscopist. Conclusion: Colonoscopy reporting varied significantly in clinical practice. Colonoscopy performance met the suggested standards; however, considerable variability between endoscopy departments was found. The results of this study underline the importance of the implementation of quality indicators and guidelines. Moreover, by continuous monitoring of quality parameters, the quality of both colonoscopy reporting and colonoscopy performance can easily be improved. (Gastrointest Endosc 2012;75:98

Santé mentale

Le dossier thématique « Santé mentale » est une discussion sur les savoirs à l’œuvre dans le champ de la santé mentale et les disciplines s’y rapportant. Son ambition est de discuter les liens et les frontières entre les théories et les pratiques dans un contexte où les définitions de ces termes font particulièrement question, aussi bien pour les acteurs de ce domaine que pour les historiens. Selon les contextes et les époques, les modèles théoriques auxquels se rattachent les pratiques thérapeutiques dans le champ de la santé mentale peuvent ou non se revendiquer d’une légitimité scientifique. Par ailleurs, de nombreuses connaissances scientifiques n’ont pas été « traduites » en pratiques. À l’inverse, dans d’autres situations la clinique fournit les données qui seront « mises en théorie » par des praticiens. Ce dossier propose différentes études de cas centrées sur le XIXe et le XXe siècle, réalisées par de jeunes chercheurs et des spécialistes en histoire sociale et culturelle des sciences. En plus du dossier thématique, on trouvera un article en varia de Nicolas Vidoni sur l’implication des services de police dans la préservation de la santé des Parisiens au XVIIIe siècle, ainsi que des recensions d’ouvrages

The Global Rating Scale in clinical practice: A comprehensive quality assurance programme for endoscopy departments

Background: The Global Rating Scale is an endoscopy quality assurance programme, successfully implemented in England. It remains uncertain whether it is applicable in another health care setting. Aim: To assess the applicability of the Global Rating Scale as benchmark tool in an international context. Methods: Eleven Dutch endoscopy departments were included for a Global Rating Scale-census, performed as a cross-sectional evaluation, July 2010. Two Global Rating Scale-dimensions - 'clinical quality' and 'patient experience' - were assessed across six items using a range of levels: from level-D (basic) to level-A (excellent). Construct validity was assessed by comparing department-specific colonoscopy audit data to GRS-levels. Results: For 'clinical quality', variable scores were achieved in items 'safety' (9% = B, 27% = C, 64% = D) and 'communication' (46% = A, 18% = C, 36% = D). All departments achieved a basic score in 'quality' (100% = D). For 'patient experience', variable scores were achieved in 'timeliness' (18%=A, 9%=B, 73%=D) and 'booking-choice' (36%=B, 46%=C, 18%=D). All departments achieved basic scores in 'equality' (100%=D). Departments obtaining level-C or above in 'information', 'comfort', 'communication', 'timeliness' and 'aftercare', achieved significantly better audit outcomes compared to those obtaining level-D (p<0.05). Conclusion: The Global Rating Scale is appropriate to use outside England. There was significant variance. across departments in dimensions. Most Global Rating Scale-levels were in line with departments' audit outcomes, indicating construct validity. (C) 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved