Out of the boxes, out of the silos: The need of interdisciplinary collaboration to reduce poor-quality medical products in the supply chain

In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area

Phenotypic spectrum of fetal Smith-Lemli-Opitz syndrome.

International audienceThe Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive multiple congenital malformation syndrome caused by dehydrocholesterol reductase deficiency. The diagnosis is confirmed by high 7- and secondarily 8-dehydrocholesterol levels in plasma and tissues and/or by detection of biallelic mutations in the DHCR7 gene. The phenotypic spectrum of SLOS is broad, ranging from a mild phenotype combining subtle physical anomalies with behavioral and learning problems, to a perinatally lethal multiple malformations syndrome. The fetal phenotype of SLOS has been poorly described in the literature. We report a series of 10 fetuses with molecularly proven SLOS. Even in young fetuses, the facial dysmorphism appears characteristic. Genital abnormalities are rare in 46,XX subjects. Gonadal differentiation appears histologically normal and in agreement with the chromosomal sex, contrary to what has been previously stated. We observed some previously unreported anomalies: ulnar hypoplasia, vertebral segmentation anomalies, congenital pulmonary adenomatoid malformation, fused lungs, gastroschisis, holomyelia and hypothalamic hamartoma. This latter malformation proves that SLOS phenotypically overlaps with Pallister-Hall syndrome which remains clinically a major differential diagnosis of SLOS

La qualité de la vie, critères d’une vie meilleure. Rapport d’enquête

Valensi Cécile, Macé Denise. La qualité de la vie, critères d’une vie meilleure. Rapport d’enquête. In: Diplômées, n°87, 1973. pp. 142-156

Qualité de l'air - Guide pratique pour l'estimation de l'incertitude de mesure des concentrations en polluants dans l'air ambiant - Partie 6 : estimation des incertitudes sur les concentrations massiques de particules mesurées en automatique: Fascicule de Documentation FD X43-070/6

Participation au Groupe d'Experts AFNOR concepteur du documentDocument visant à aider les utilisateurs de systèmes automatiques de mesure de la concentration massique de particules en suspension dans l'air ambiant (PM10 & PM2,5), à déterminer l'incertitude associée aux résultats de mesure fournis pour l'ensemble de la gamme de mesure utilisée. Cet guide concernant les mesurages réalisés sur site, présente la procédure d'estimation de l'incertitude associée à un résultat de mesure d'un analyseur automatique, à l'aide d'un budget d'incertitude

Qualité de l'air - Guide pratique pour l'estimation de l'incertitude de mesure des concentrations en polluants dans l'air ambiant - Partie 1 : généralités: Fascicule de Documentation FD X43-070/1

participation au Groupe d'Experts AFNOR concepteur du documentDocument visant à aider les utilisateurs de systèmes automatiques ou manuels de mesure de concentrations en polluants gazeux à l'air ambiant, à déterminer l'incertitude associée aux résultats de mesure fournis pour l'ensemble de la gamme de mesure utilisée. Il décrit comment établir un budget d'incertitudes à partir des caractéristiques de performance de la méthode incluant la ligne de prélèvement associée et la technique analytique, en prenant en compte les conditions d'environnement pouvant avoir une influence sur le résultat de mesure. Le présent document, basé à la fois sur les spécifications de la norme NF EN ISO 14956 et sur le GUM (guide pour l'expression de l'incertitude de mesure (NF ISO/IEC GUIDE 98-3) , décrit comment établir les budgets d'incertitudes dans le cas des mesurages à l'air ambiant

Cessation of extracorporeal photopheresis in chronic lung allograft dysfunction: effects on clinical outcome in adults

BACKGROUND Extracorporeal photopheresis (ECP) has been reported to be safe and the ultimate treatment option in lung transplant recipients with chronic lung allograft dysfunction (CLAD), the main overall cause of mortality in lung transplant recipients. However, ECP is not reimbursed in selected health jurisdictions, and reimbursement by health insurance providers is a major issue. In Switzerland, ECP is not recognised by the health authorities as a therapy option for CLAD; thus by the end of 2014, ECP had to be stopped in the majority of adult lung transplant recipients cared for at the University Hospital Zurich because of lack of continuous funding. OBJECTIVE To describe the outcome of lung transplant recipients after forced cessation of ECP treatment. METHOD We retrospectively analysed outcome of 12 lung transplant recipients undergoing ECP for different phenotypes of CLAD (bronchiolitis obliterans syndrome, restrictive allograft syndrome) at our centre followed-up for 12 months after forced cessation of ECP. RESULTS Within the 12 months after treatment cessation, seven patients (58%) died with a median survival of 207 days (range 6-365 days). Lung function (FEV1, forced expiratory volume in 1 second) declined significantly 6 months after ECP cessation (p = 0.003). CONCLUSION Our data support the role of ECP as valuable treatment option in lung transplant recipients with CLAD

Pour les sciences sociales. 101 livres

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Medicines availability for non-communicable diseases: the case for standardized monitoring

Background: In response to the global burden of non-communicable diseases (NCDs), the World Health Organization (WHO) has developed a Global Action Plan that includes a voluntary medicines target of 80% availability and affordability of essential medicines for the prevention and treatment of diabetes, cardiovascular disease and respiratory disease both in public and private health facilities. Reliable measures of medicines availability are needed to track progress towards meeting this target. The results of three studies measuring the availability of medicines for hypertension and diabetes conducted in Tanzania in 2012–2013 were compared to assess the consistency of the results across the studies. Methods: Availability was defined by observation of the medicine (no minimum quantity) on the day of the survey. The three studies involved 24, 107 and 1297 health facilities. Estimates of the availability of medicines for hypertension and diabetes were compared for medicines availability overall, by managing authority (government, mission/faith-based, private-for-profit), by facility level (hospital, health centre, dispensary) and by setting (urban, rural). Results: Comparisons of the availability of medicines were limited by differences in the definitions of the medicines and the classifications of the facilities surveyed. Metformin was variously reported as available in 33%, 39%, 46%, and 57% of facilities. Glibenclamide availability ranged from 19% to 52%. One study reported low levels of insulin availability (9-16% depending on insulin type) compared to 34% in a second study. Captopril (or angiotensin converting enzyme [ACE] inhibitor) availability ranged from 13% to 48%while availability of calcium channel blockers was 29% to 57% and beta-blockers 15% to 50%. Trends were similar across studies with lower availability in government compared to mission or private facilities, in dispensary and health centres compared to hospitals, and in rural compared to urban facilities. Conclusions: All three studies showed suboptimal availability of NCD medicines, however the estimates of availability differed. Regular monitoring using reproducible methods and measuring key medicines must replace ad-hoc studies, small selected samples and differences in definitions. Low and middle-income countries need to implement monitoring and evaluation systems to track progress towards meeting the NCD medicines target and to inform country-level interventions to improve access to NCD medicines

2001 Callon, Lascoumes et Barthe repensent la démocratie

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