Recours spontané aux urgences

Objectif : Analyser les caractéristiques sociodémographiques et les déterminants du recours spontané aux urgences des patients et évaluer leurs ressentis d'urgence et de gravité en les comparant à l'avis du médecin. Matériels et Méthodes : Etude prospective réalisée aux urgences du CH de Saumur et du CHU d'Angers, basée sur la distribution d un questionnaire à tout patient adulte, se présentant sans avis médical préalable, et aux médecins les prenant en charge. Le recueil s est fait 24h sur 24, sur une semaine en juillet 2011 et en janvier 2012. Résultats : 22.9% des admissions ont été incluses. Cette population était souvent jeune, active, masculine, consultant pour de la traumatologie apparue dans les 24 dernières heures. 56.5% venaient pendant les horaires de gardes. 10.5% des patients inclus ont tenté de joindre leur médecin traitant, dont 56.9% se présentant aux urgences car ce dernier était injoignable. 57.3% des patients n ayant pas tenté de joindre leur médecin, se sont présentés aux urgences afin de soulager un symptôme. En proportion, il y avait plus d'inclus à Saumur qu'à Angers (27,2% vs 20,8%), ils étaient plus nombreux à évoquer la facilité de l'accès aux soins à Saumur et en été. Les sentiments d urgence et/ou de gravité sont cités par 62,1 % de la population incluse. Ce ressenti est globalement discordant avec l évaluation du médecin. Conclusion : L'évaluation de l'urgence ou de la gravité d'un problème médical est subjective tant pour le médecin que pour le patient. Souvent par méconnaissance de l'organisation de la permanence des soins, le recours spontané aux urgences est motivé par une plus grande facilité d'accès aux soins.Objective: Analyze the patients sociodemographic characteristics and their determinants of the emergency service spontaneous recourse and assess their feelings of urgency and severity, comparing them with the doctor s opinion. Materials and Methods: Prospective study carried on the emergency service of the Saumur Hospital Center and Angers University Hospital, based on the distribution of a questionnaire to any adult patient, going to the emergency service without preliminary medical advice, and to supporting doctors. The collection has been made 24 hours a day, over two weeks, one in July 2011 and another in January 2012. Results: 22.9% of the patients admitted were included. Most of them were young, active, male, consulting for a traumatology appeared in the last 24 hours. 56.5% came during the guard hours. 10.5% of the patients included tried to join their regular doctor, whose 56.9% went to the emergencies because their doctor was unreachable. 57.3% of the patients who did not join their regular doctor, came to the emergencies to relieve a symptom. Proportionally, there were more patients included in Saumur than in Angers (27.2% vs 20.8%), they were more to mention the easiness access to care in Saumur in during the summer. Feelings of urgency and / or gravity are mentioned by 62.1% of the population included. This feeling is generally discordant with the doctor s evaluation. Conclusion: The evaluation of the emergency or the severity of medical problem is subjective as for the doctor and for the patient. Often, because of the lack of knowledge of the care presence organisation, the emergency service spontaneous recourse is motivated by a better care access.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Psychosocial Impact of Predictive Genetic Testing in Hereditary Heart Diseases: The PREDICT Study

International audiencePredictive genetic testing (PGT) is offered to asymptomatic relatives at risk of hereditary heart disease, but the impact of result disclosure has been little studied. We evaluated the psychosocial impacts of PGT in hereditary heart disease, using self-report questionnaires (including the State-Trait Anxiety Inventory) in 517 adults, administered three times to the prospective cohort (PCo: n = 264) and once to the retrospective cohort (RCo: n = 253). The main motivations for undergoing PGT were "to remove doubt" and "for their children". The level of anxiety increased between pre-test and result appointments (p <0.0001), returned to baseline after the result (PCo), and was moderately elevated at 4.4 years (RCo). Subjects with a history of depression or with high baseline anxiety were more likely to develop anxiety after PGT result (p = 0.004 and p <0.0001, respectively), whatever it was. Unfavourable changes in professional and/or family life were observed in 12.4% (PCo) and 18.7% (RCo) of subjects. Few regrets about PGT were expressed (0.8% RCo, 2.3% PCo). Medical benefit was not the main motivation, which emphasises the role of pre/post-test counselling. When PGT was performed by expert teams, the negative impact was modest, but careful management is required in specific categories of subjects, whatever the genetic test result