[Can narrative medicine be an answer to patient physician relationship teaching according to students' demand in medical education curricula?].

Introduction: Coming from literature and medicine and medical humanities north American seminars, narrative medicine has applied narratology for analyzing patients' discourse and has been taught during a decade.

Methods: At Paris Descartes School of Medicine a twenty-hour narrative medicine elective program including whole class lectures and writing and reading small group exercises for second year medical students has been assessed using satisfaction questionnaires.

Results: Although several students were uncomfortable with the first writing and reading exercises, the whole satisfaction scores demonstrate that this new program is very well appreciated even when students did not choose this program because they were interested with the patient physician relationship.

Work week duration, work-family balance and difficulties encountered by female and male physicians: results from the French SESMAT study.

Objective: France encounters difficulties attracting physicians to work in hospitals. Organisation at work and at home may be at the heart of the problem for female as well as for male physicians.

Participants: A comprehensive questionnaire was filled out online by a representative sample of 1924 French hospital physicians.

Emergency physicians accumulate more stress factors than other physicians-results from the French SESMAT study.

Introduction: France is facing a shortage of available physicians due to a greying population and the lack of a proportional increase in the formation of doctors. Emergency physicians are the medical system's first line of defence.

Methods: The authors prepared a comprehensive questionnaire using established scales measuring various aspects of working conditions, satisfaction and health of salaried physicians and pharmacists.

[2003 clinical practice guideline: Standards, Options and Recommendations for pain assessment in adult and children with cancer (summary report)].

Context: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the French Federation of Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients.

Objective: To update clinical practice guidelines for the assessment of pain in adult or children with cancer in collaboration with the French society for pain study and treatment.

[Palliative care mobile team at a Parisian university hospital].

Ever since 1987 in France, palliative care is developing in hospitals through PCU and mobile teams. The arbitrary split between care and cure could find its origin in the history of the "cancer war" and in the lack of interest of doctors for patients at the end of their lives. The evolution of mindsets in modern societies goes together with the emergence of the individual, modifying at the same time the perception of pain.

[Evaluation of cognitive disorders and screening of delirium in cancer patients receiving morphine. Comparison of the use of the Elementary Test of Concentration, Orientation and Memory (TELECOM)and of the Mini-Mental State Examination (MMSE)].

Objective: The Mini Mental State Examination (MMSE) is the gold standard cognitive test for screening delirium in cancer patients on opioids. But the MMSE is long and requires writing, reading and drawing from patients with various degrees of physical inability. Age and educational level affect the MMSE score.

The use of steroids in the management of inoperable intestinal obstruction in terminal cancer patients: do they remove the obstruction?

This multicentre, randomized double-blind study was undertaken to assess the efficacy of corticosteroids as a palliative treatment of intestinal obstruction due to advanced and incurable cancer. Thirty-one French palliative care units agreed to participate in the study and 12 actually recruited at least one patient. To be included, patients had to have an advanced cancer with a surgically inoperable bowel obstruction and to have received no specific anticancer therapy within the preceding 28 days.

Physicians' recognition of the symptoms experienced by HIV patients: how reliable?

To assess how well physicians recognize common symptoms in HIV patients and identify factors associated with symptom recognition, a multicenter cross-sectional survey was performed in a random sample of 118 hospitalized and 172 ambulatory HIV patients, and their attending physicians. Patients' reports of 16 different symptoms were compared to physicians' reports of whether each symptom was present and/or specific treatments prescribed. Overall, fatigue, anxiety, skin problems, fever, and weight loss were more often recognized by physicians than other symptoms.

Platelet transfusions in advanced hematological malignancies: a position paper.

Treatment of patients with advanced-stage hematological malignancies (HM) includes frequent transfusions. Given present limited hospital budgets, administrative pressure is increasing on hematology services to limit the cost of these transfusions. An expert multidisciplinary panel involved in hematology formed a working party to draw up a series of proposals, including definitions of advanced stage disease and the indications for platelet transfusion.

[Demand for the stopping of chronic hemodialysis. Apropos of 1 case].

We reported a case of a 69 years old woman who requested stopping long-term dialysis. She did not suffer a serious medical deterioration, except a worsening quality of life. After a global evaluation (medical, psychologic and social), several propositions to increase her state of life done.

The Palliative Care Centre of Hôtel-Dieu Hospital.

In 1989, two affiliations of Centre de Soins Palliatifs were created by the Assistance Publique-Hôpitaux de Paris, the largest medical complex in Europe. At Hôtel-Dieu de Paris, a mobile team from Soins Palliatifs was formed. The members were recruited from hospital services in order to help the team in the care and support of patients with advanced diseases.

[Indications of analgesia with absolute alcohol or phenol for intractable pain in thoracic and abdominal cancerous pathology (author's transl)].

This work analyzes the results of 88 blocks for intractable pain in thoracic and abdominal malignant diseases. Results and duration of analgesia are compared in regard to the localization of pain and to the use of alcohol or phenol. Best analgesic results are obtained in the pelvic pains and especially in the colorectal pains.

[Headaches and subarachnoïd anaesthesia. Prevention by new technique (author's transl)].

The authors study the influence of a new subarachnoïd anasthesia technique on the incidence of headaches. A statistical survey is carried out on two homogeneous samples of patients who had undergone urologic surgery.

[A comparison of anaesthetic awakening with out-patients treated by maxillo-facial surgery using 4 different anaesthetic techniques (author's transl)].

To estimate and compare the awakening period following 4 different anaesthetic techniques (enflurane and halothane and two intraveinous anaesthetic substances: propanidide and althesin), the authors examined 120 outpatients who had undergone maxillo-facial surgery distributed over 4 sample groups of 30 each. A statistical analysis of the responses to psycho-dianostic tests has not enabled the authors to decide which anaesthetic ambulatory technique is preferable.

[False diagnosis of post-operative massive pulmonary embolism. Nine observations (author's transl)].

After having studied nine observations about patients referred to them for embolectomy under CEC on suspicion of massive pulmonary embolism, the authors describe five differential diagnosis and how they can be reached. A low central venous pressure, an hypoxaemia sensitive to oxygenotherapy, a high pulmonary wedge pressure or the lack of diastolocapillary gradient, and, last of all, a real hypocoagulability attained by the use of low and daily doses of heparin must make one cautious. Yet, if a doubt should persist, an angiography and/or a scintigraphy will be asked for.