Étude de la variation des résultats des ECBU dans les infections urinaires des patients diabétiques et non diabétiques : une étude transversale observationnelle et analytique

Les patients diabétiques ont un risque plus élevé de développer une infection urinaire (IU) que les patients non diabétiques. L'objectif de notre étude était d'étudier l'épidémiologie bactérienne des IU en population générale, puis de comparer espèces et résistances aux antibiotiques chez les diabétiques avec les non diabétiques. Notre étude transversale était menée dans 12 laboratoires de ville et incluait tout patient majeur se présentant pour effectuer un ECBU. Un questionnaire renseignant les facteurs de risque d'IU et l'existence d'un diabète leur était remis. Les bactéries des ECBU satisfaisant les critères d'IU et leurs résistances pour cinq classes d'antibiotiques étaient analysées. 1119 patients dont 124 patients diabétiques avaient des ECBU positifs. En population générale, sans différence avec les diabétiques, les bactéries impliquées étaient: E. Coli (73%), Entérocoques (7%), Klebsielles (6%), Proteus (4%), Staphylocoques (3%) et Pseudomonas (2%). Il n'y avait pas de différence de résistances des E. Coli chez les diabétiques par rapport à la population générale (ofloxacine: respectivement 24% vs 17%, céfixime : 6% vs 6%, co-trimoxazole : 24% vs 24%, nitrofurantoïne : 2% vs 2%, fosfomycine: 0% vs 1%). Une augmentation chez les diabétiques des résistances à l'ofloxacine pour l'ensemble des bactéries était proche de la significativité après ajustement sur les facteurs de risque d'IU (OR=1,49 ; p=0,1). Les recommandations sur les IU visant à diminuer les résistances aux quinolones sont concordantes avec nos résultats. Chez les diabétiques, une augmentation non significative des résistances à l'ofloxacine, qu'il faudrait explorer par d'autres études, était retrouvée

Combination of hydroxychloroquine and azithromycin as a treatment of Covid-19. Results of an observational study including 80 Covid-19 patients

National audienc

Impact of integrating objective structured clinical examination into academic student assessment: Large-scale experience in a French medical school

International audiencePurpose: Objective structured clinical examinations (OSCE) evaluate clinical reasoning, communication skills, and interpersonal behavior during medical education. In France, clinical training has long relied on bedside clinical practice in academic hospitals. The need for a simulated teaching environment has recently emerged, due to the increasing number of students admitted to medical schools, and the necessity of objectively evaluating practical skills. This study aimed at investigating the relationships between OSCE grades and current evaluation modalities.Methods: Three-hundred seventy-nine 4th-year students of University-of-Paris Medical School participated to the first large-scale OSCE at this institution, consisting in three OSCE stations (OSCE#1–3). OSCE#1 and #2 focused on cardiovascular clinical skills and competence, whereas OSCE#3 focused on relational skills while providing explanations before planned cholecystectomy. We investigated correlations of OSCE grades with multiple choice (MCQ)-based written examinations and evaluations of clinical skills and behavior (during hospital traineeships); OSCE grade distribution; and the impact of integrating OSCE grades into the current evaluation in terms of student ranking.Results: The competence-oriented OSCE#1 and OSCE#2 grades correlated only with MCQ grades (r = 0.19, P0.75). Conversely, the behavior-oriented OSCE#3 grades correlated with traineeship skill and behavior grades (r = 0.19, P<0.001, and r = 0.12, P = 0.032), but not with MCQ grades (P = 0.09). The dispersion of OSCE grades was wider than for MCQ examinations (P<0.001). When OSCE grades were integrated to the final fourth-year grade with an incremental 10%, 20% or 40% coefficient, an increasing proportion of the 379 students had a ranking variation by ±50 ranks (P<0.001). This ranking change mainly affected students among the mid-50% of ranking.Conclusion: This large-scale French experience showed that OSCE designed to assess a combination of clinical competence and behavioral skills, increases the discriminatory capacity of current evaluations modalities in French medical schools

eOSCE stations live versus remote evaluation and scores variability

International audienceAbstract Background Objective structured clinical examinations (OSCEs) are known to be a fair evaluation method. These recent years, the use of online OSCEs (eOSCEs) has spread. This study aimed to compare remote versus live evaluation and assess the factors associated with score variability during eOSCEs. Methods We conducted large-scale eOSCEs at the medical school of the Université de Paris Cité in June 2021 and recorded all the students’ performances, allowing a second evaluation. To assess the agreement in our context of multiple raters and students, we fitted a linear mixed model with student and rater as random effects and the score as an explained variable. Results One hundred seventy observations were analyzed for the first station after quality control. We retained 192 and 110 observations for the statistical analysis of the two other stations. The median score and interquartile range were 60 out of 100 (IQR 50–70), 60 out of 100 (IQR 54–70), and 53 out of 100 (IQR 45–62) for the three stations. The score variance proportions explained by the rater (ICC rater) were 23.0, 16.8, and 32.8%, respectively. Of the 31 raters, 18 (58%) were male. Scores did not differ significantly according to the gender of the rater ( p = 0.96, 0.10, and 0.26, respectively). The two evaluations showed no systematic difference in scores ( p = 0.92, 0.053, and 0.38, respectively). Conclusion Our study suggests that remote evaluation is as reliable as live evaluation for eOSCEs

eOSCE stations live versus remote evaluation and scores variability

International audienceAbstract Background Objective structured clinical examinations (OSCEs) are known to be a fair evaluation method. These recent years, the use of online OSCEs (eOSCEs) has spread. This study aimed to compare remote versus live evaluation and assess the factors associated with score variability during eOSCEs. Methods We conducted large-scale eOSCEs at the medical school of the Université de Paris Cité in June 2021 and recorded all the students’ performances, allowing a second evaluation. To assess the agreement in our context of multiple raters and students, we fitted a linear mixed model with student and rater as random effects and the score as an explained variable. Results One hundred seventy observations were analyzed for the first station after quality control. We retained 192 and 110 observations for the statistical analysis of the two other stations. The median score and interquartile range were 60 out of 100 (IQR 50–70), 60 out of 100 (IQR 54–70), and 53 out of 100 (IQR 45–62) for the three stations. The score variance proportions explained by the rater (ICC rater) were 23.0, 16.8, and 32.8%, respectively. Of the 31 raters, 18 (58%) were male. Scores did not differ significantly according to the gender of the rater ( p = 0.96, 0.10, and 0.26, respectively). The two evaluations showed no systematic difference in scores ( p = 0.92, 0.053, and 0.38, respectively). Conclusion Our study suggests that remote evaluation is as reliable as live evaluation for eOSCEs