INTERET DE LA SCINTIGRAPHIE A LA MIBG POUR L'EVALUATION PRONOSTIQUE DES PATIENTS INSUFFISANTS CARDIAQUES TRAITES PAR BETABLOQUANTS

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

PREVALENCE DE LA COQUELUCHE CHEZ L'ADULTE PRESENTANT UNE TOUX PERSISTANTE ET CONSULTANT EN MEDECINE GENERALE

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Les jeunes et leur médecin traitant (pour une meilleure prise en charge des conduites à risque)

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

QUELLE PLACE ET QUEL DEVENIR POUR LA VISITE MEDICALE A DOMICILE EN FRANCE (EST-ELLE ENCORE JUSTIFIEE ?)

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Pulmonary embolism

Complete occlusion of a peripheral pulmonary artery usually results in a pulmonary infarction with pleuritic chest pain and haemoptysis. When the blood clot is lodged in more proximal pulmonary arteries and is not occlusive, pulmonary infarction does not occur and pulmonary embolism might present as isolated dyspnoea. Massive pulmonary embolism is caused by large bilateral proximal clots resulting in haemodynamic collapse

Mandatory vaccination of infants in France: Is that the way forward?

In this opinion paper, the authors argue that the extension of mandatory immunization of infants up to two years of age from three diseases (diphtheria, tetanus, poliomyelitis) to 11 diseases, introduced in France in January 2018, is not a sustainable response to the challenge of controlling vaccine-preventable diseases. In France in 2017, infant immunization coverage (IC) rates were sufficiently high or increasing (hepatitis B), except for measles, mumps and rubella (MMR) and meningococcus C disease. Even if vaccination obligation makes it possible to achieve the MMR IC objectives among infants, communication programmes and supported advice from GPs are essential for the catch-up of susceptible adults to obtain herd immunity. The impact of mandatory immunization on hesitancy remains uncertain, and it contradicts the evolution of the patient’s role in the governance of his own health and the principle of autonomy. Numerous studies have shown that interventions and advice from health professionals improve vaccine acceptance. To correct the poor implementation of some vaccination programmes by health professionals, strong communication and resources from health authorities are needed, rather than a retreat towards obligation. Reducing missed opportunities and increasing access to immunization are essential objectives. Finally, an immunization policy based on primary care and a patient-centred approach to each vaccination are more likely to reduce vaccine hesitancy, sustainably

How GPs adapted their practices and organisations at the beginning of COVID-19 outbreak: a French national observational survey

International audienceObjectives To describe how general practitioners (GPs) adapted their practices to secure and maintain access to care in the epidemic phase. A secondary objective was to explore if GPs’ individual characteristics and type of practice determined their adaptation.Design Observational study using an online questionnaire. Organisational changes were measured by a main question and detailed in two specific outcomes. To identify which GPs’ characteristics impacted organisational changes, successive multivariate logistic modelling was performed. First, we identified the GPs’ characteristics related to organisational changes with a univariate analysis. Then, we tested the adjusted associations between this variable and the following GPs’ characteristics: age, gender and type of practice.Setting The questionnaire was administered online between 14 March and 21 March 2020. Practitioners were recruited by email using the contact lists of different French scientific GP societies.Participants The target population was GPs currently practising in France (n=46 056). We obtained a total of 7481 responses.Primary and secondary outcome measures Primary outcome: Proportion of GPs who adapted their practice. Secondary outcome: GPs’ characteristics related to organisational changes.Results Among the 7481 responses, 5425 were complete and were analysed. 3849 GPs (70.9%) changed their activity, 3605 GPs (66.5%) increased remote consultations and 2315 GPs (42.7%) created a specific pathway for probable patients with COVID-19. Among the 3849 GPs (70.9%) who changed their practice, 3306 (91.7%) gave more answers by phone, 996 (27.6%) by email and 1105 (30.7%) increased the use of video consultations. GPs working in multi-professional group practices were more likely to have changed their activity since the beginning of the epidemic wave than GPs working in mono-professional group or single medical practices (adjusted OR: 1.32, 95% CI 1.12 to 1.56, p=0.001).Conclusions French GPs adapted their practices regarding access to care for patients in the context of the COVID-19 epidemic. This adaptation was higher in multi-professional group practices

How GPs adapted their practices and organisations at the beginning of COVID-19 outbreak: a French national observational survey

International audienceObjectives To describe how general practitioners (GPs) adapted their practices to secure and maintain access to care in the epidemic phase. A secondary objective was to explore if GPs’ individual characteristics and type of practice determined their adaptation.Design Observational study using an online questionnaire. Organisational changes were measured by a main question and detailed in two specific outcomes. To identify which GPs’ characteristics impacted organisational changes, successive multivariate logistic modelling was performed. First, we identified the GPs’ characteristics related to organisational changes with a univariate analysis. Then, we tested the adjusted associations between this variable and the following GPs’ characteristics: age, gender and type of practice.Setting The questionnaire was administered online between 14 March and 21 March 2020. Practitioners were recruited by email using the contact lists of different French scientific GP societies.Participants The target population was GPs currently practising in France (n=46 056). We obtained a total of 7481 responses.Primary and secondary outcome measures Primary outcome: Proportion of GPs who adapted their practice. Secondary outcome: GPs’ characteristics related to organisational changes.Results Among the 7481 responses, 5425 were complete and were analysed. 3849 GPs (70.9%) changed their activity, 3605 GPs (66.5%) increased remote consultations and 2315 GPs (42.7%) created a specific pathway for probable patients with COVID-19. Among the 3849 GPs (70.9%) who changed their practice, 3306 (91.7%) gave more answers by phone, 996 (27.6%) by email and 1105 (30.7%) increased the use of video consultations. GPs working in multi-professional group practices were more likely to have changed their activity since the beginning of the epidemic wave than GPs working in mono-professional group or single medical practices (adjusted OR: 1.32, 95% CI 1.12 to 1.56, p=0.001).Conclusions French GPs adapted their practices regarding access to care for patients in the context of the COVID-19 epidemic. This adaptation was higher in multi-professional group practices