Unusual presentation of acute annular urticaria: A case report

Acute urticarial lesions may display central clearing with ecchymotic or haemorrhagic hue, often misdiagnosed as erythema multiforme, serum-sickness-like reactions, or urticarial vasculitis. We report a case of acute annular urticaria with unusual presentation occurring in a 20-month-old child to emphasize the distinctive morphologic manifestations in a single disease. Clinicians who care for children should be able to differentiate acute urticaria from its clinical mimics. A directed history and physical examination can reliably orientate necessary diagnostic testing and allow for appropriate treatment

Regulation of healthcare ethics committees in Europe

In this article, the question is discussed if and how Healthcare Ethics Committees (HECs) should be regulated. The paper consists of two parts. First, authors from eight EC member countries describe the status quo in their respective countries, and give reasons as to the form of regulation they consider most adequate. In the second part, the country reports are analysed. It is suggested that regulation of HECs should be central and weak. Central regulation is argued to be apt to improve HECs’ accountability, relevance and comparability. To facilitate biomedical citizenship and ethical reflection, regulation should at the same time be weak rather than strict. Independence of HECs to deliberate about ethical questions, and to give solicited and unsolicited advice, should be supported and only interfered with by way of exception. One exception is when circumstances become temporary adversarial to ethical deliberation in healthcare institutions. In view of European unification, steps should be taken to develop consistent policies for both Eastern and Western European countries

La parole du médecin à l'épreuve de l'enfant qui refuse

La place de l'enfant dans la société a changé radicalement au cours de l'histoire. Initialement sans aucun droit, il est aujourd'hui considéré comme un sujet libre doté de droits fondamentaux. L'exercice de ces droits fait question dès lors que l'on s'interroge ce qu'est l'état de minorité en référence à l'usage possible de la volonté comme puissance législatrice autonome. Dans le domaine du soin, l'intérêt supérieur de l'enfant et sa participation aux décisions le concernant posent des questions particulières quand il refuse. L'évaluation objective de ses facultés de compréhension pose en soi des problèmes et n'est pas l'unique constituant d'une réflexion éthique. Le problème fondamental d'une telle évaluation est qu'elle soit motivée par un refus irrationnel à une proposition supposée rationnelle. Les autres dimensions de la réflexion éthique relèvent de la notion même d'enfance, c'est à dire de la position assignée aux enfants aujourd'hui dans le monde. L'intérêt supérieur de l'enfant est une notion intelligible à la fois dans le domaine privé et le domaine public. La question de savoir en quels lieux nous devons poser une parole lorsque l'enfant refuse est une question permanente pour le médecin.PARIS7-Villemin (751102101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Technologie de l’information et de la communication et santé des seniors

International audienc

The contribution of French patient and consumer groups to health technology assessments over a 2-year period: an observational retrospective study

International audienceBackground In 2017, The French National Authority for Health (HAS) created an open, online, systematic contribution process to enable patient and consumer groups (PCGs) to contribute to health technology assessment (HTA) carried out to aid public authorities in reimbursement and pricing decision making. Objectives This retrospective study analyzes how French PCGs contributed to the HTA process within the HAS for the first 2 years of this new mechanism. Methods PCG contributions received between 01 January 2017 and 31 December 2018 and the recording of deliberations leading to reports of the corresponding HTAs were included. Analysis grids were designed by the investigators with 5 rounds of refinement tests on 10 random PCG contributions and the reports. Systematic data extraction was then performed separately by two investigators. PCG answers to the open-question templates and the related final HTA report published by the HAS were analyzed. Results Seventy-nine contributions from 44 PCGs were received and analyzed by the HAS for 78 out of the 592 HTAs performed for drugs or medical devices during the 2-year period. Twenty-five percent of the HTAs performed for drugs received at least one contribution. The contributions covered quality-of-life aspects, access to care, and personal and family impact. Membership and budget of the contributing PCGs varied greatly. Conclusions The experience gained in the first 2 years demonstrates the feasibility of the process and the fact that PCG contribution actually provides relevant input on the patient perspective for HTAs used for reimbursement decisions. The challenges identified on the side of PCGs were time constraints and human resources