Patients' preferences in transplantation from marginal donors: results of a discrete choice experiment.

To increase the donor pool, the strategy of transplantation from "marginal" donors was developed though patients' preferences about these donors were insufficiently known. The preferences of patients registered on the waiting list or already transplanted in eight transplant teams covering four main organs (i.e.

Assessment of the contribution of morbidity and mortality conferences to quality and safety improvement: a survey of participants' perceptions.

Background: Evidence for the effectiveness of the morbidity and mortality conferences in improving patient safety is lacking. The aim of this survey was to assess the opinion of participants concerning the benefits and the functioning of morbidity and mortality conferences, according to their organizational characteristics.

Methods: We conducted a survey of professionals involved in a morbidity and mortality conference using a self-administered questionnaire in three French teaching hospitals in 2012.

Impact of a pilot team on patients' pain reduction and satisfaction in an emergency department: A before-and-after observational study.

Background: Pain management and patient satisfaction were targeted in the emergency department of a Paris university hospital. In 1999, 77.0% of patients complained of pain on arrival and more than half of patients did not experience pain relief at discharge.

Characteristics of morbidity and mortality conferences associated with the implementation of patient safety improvement initiatives, an observational study.

Background: The aim of this study was to identify the characteristics of morbidity and mortality conferences (MMCs) associated with the implementation of patient health-care quality and safety improvement initiatives.

Methods: We conducted an observational study of MMCs and followed up improvement initiatives for 1 year. Data on MMC baseline characteristics were abstracted using document analysis and observation of a meeting in three university hospitals in France (Grenoble, Nice, and Cochin [Paris] hospitals).

Subjective parameters markedly limit the referral of transplantation candidates to liver transplant centres.

Background & Aims: Equality of access to organ transplantation is a mandatory public health requirement. Referral from a local to a university hospital and then registration on the national waiting list are the two key steps enabling access to liver transplantation (LT). Although the latter procedure is well defined using the Model for End-stage Liver Disease score that improves equality of access, the former is mostly reliant on the practices of referring physicians.

What Kind of Information About Marginal Donors Is Available Through Sources Other Than Health Care Professionals for Patients on the Waiting List for Organ Transplantation?

Background: The current organ shortage has necessitated expanding the criteria for potential donations to marginal donors (older or sick donors whose organs would have been considered unsuitable before). In France, physicians are not required to provide information to recipients about marginal donors except for hepatitis C or hepatitis B infection and non-heart-beating donations. We hypothesized that patients can be informed about these risks by other information sources than health care professionals, such as websites and patient associations.

Management of nonfunctioning pituitary incidentaloma.

Prevalence of pituitary incidentaloma is variable: between 1.4% and 27% at autopsy, and between 3.7% and 37% on imaging.

Impact of the healthcare payment system on patient access to oral anticancer drugs: an illustration from the French and United States contexts.

Background: Oral anticancer drugs (OADs) allow treating a growing range of cancers. Despite their convenience, their acceptance by healthcare professionals and patients may be affected by medical, economical and organizational factors. The way the healthcare payment system (HPS) reimburses OADs or finances hospital activities may impact patients' access to such drugs.

Adherence to international follow-up guidelines in type 2 diabetes: a longitudinal cohort study in Luxembourg.

Introduction: Type 2 diabetes is associated with severe micro- and macro-vascular complications. Physicians' and patients' adherence to follow-up guidelines permits postponing or reducing these complications. The objectives were to assess the level of adherence to fundamental follow-up guidelines and determine patients' characteristics associated with this level of adherence in the context of Luxembourg, where no guidelines were implemented.

Budget impact analysis of the use of oral and intravenous anti-cancer drugs for the treatment of HER2-positive metastatic breast cancer.

Objectives: Two anti-cancer drugs are currently approved for the treatment of HER2-positive metastatic breast cancer (MBC): trastuzumab-based therapy (TBT) administered intravenously as first line therapy until disease progression and lapatinib, an oral self-administered dual therapy with capecitabine (L+C) as second intention for patients who continue to progress despite TBT. In current practice, TBT is still prescribed beyond disease progression. In addition to medical reasons, the difficulty to switch eligible patients to oral drugs may also be explained by economic reasons.

Burden of breast cancer with brain metastasis: a French national hospital database analysis.

Objective: Incidence of breast cancer with brain metastases (BCBM) is increasing, especially among patients over-expressing HER2. Epidemiology on this sub-type of cancer is scarce, since cancer registries carry no information on the HER2 status. A retrospective database analysis was conducted to estimate the burden of BCBM, especially among HER2-positive patients in a secondary objective.

Physicians' preferences for prescribing oral and intravenous anticancer drugs: a Discrete Choice Experiment.

Although efficacy and tolerability are classical criteria for treatment choice, patient adherence and tariff issues related to novel oral anticancer drugs may also influence therapeutic decisions. We estimated the relative influence of efficacy, tolerability, expected adherence and route of administration of a chemotherapy treatment on 203 French physicians' preferences who participated in a Discrete Choice Experiment (DCE), a quantitative method used to elicit preferences. From a questionnaire with six scenarii, respondents had to choose between two treatments which differed with respect to these four attributes.

An algorithm to identify patients with treated type 2 diabetes using medico-administrative data.

Background: National authorities have to follow the evolution of diabetes to implement public health policies. An algorithm was developed to identify patients with treated type 2 diabetes and estimate its annual prevalence in Luxembourg using health insurance claims when no diagnosis code is available.

Methods: The DIABECOLUX algorithm was based on patients' age as well as type and number of hypoglycemic agents reimbursed between 1995 and 2006.

Prognostic factors of disease-free survival after thyroidectomy in 170 young patients with a RET germline mutation: a multicenter study of the Groupe Francais d'Etude des Tumeurs Endocrines.

Background: In hereditary medullary thyroid carcinoma (HMTC), prophylactic surgery is the only curative option, which should be properly defined both in time and extent.

Objectives: To identify and characterize prognostic factors associated with disease-free survival (DFS) in children from HMTC families.

Design: We conducted a retrospective analysis of a multi-center cohort of 170 patients below age 21 at surgery.

Prevalence of neuropathic pain in emergency patients: an observational study.

Objective: Neuropathic pain (NP) in acute conditions has been poorly investigated. A diagnostic score, the DN4 scale (DN4), has been developed to help physicians to detect and treat NP appropriately. DN4 is a 10-item questionnaire.

Might physicians be restricting access to liver transplantation for patients with alcoholic liver disease?

Background/aims: In France, the most common cause of cirrhosis is excessive alcohol consumption. Post-transplant survival rates in patients with alcoholic liver disease (ALD) are at least as good as those seen with other indications. However, fewer of these patients are found on the waiting list.

Evolution of patients' complaints in a French university hospital: is there a contribution of a law regarding patients' rights?

Background: Legislative measures have been identified as one effective way of changing attitude or behaviour towards health care. The aim of this study was to describe trends in patients' complaints for medical issues; to evaluate the contribution of a law regarding patients' rights, and to identify factors associated to patients' perception of a medical error.

Methods: Patients with a complaint letter for medical issues in a French university hospital were included.

Knowledge, attitudes and vaccination coverage of healthcare workers regarding occupational vaccinations.

Objectives: Immunization of healthcare workers (HCWs) is a major issue for infection control in healthcare facilities. The aim of this study was to evaluate knowledge regarding occupational vaccinations, HBV, varicella and influenza vaccination rates and attitudes towards influenza vaccine among HCWs.

Design And Setting: A cross-sectional survey was conducted in two wards (Medicine and Paediatrics) of a 1182-bed teaching hospital in Paris, France.

Access to care of patients with chronic hepatitis C virus infection in a university hospital: Is opioid dependence a limiting condition?

Background: We aimed to examine access to care of opioid-dependent patients with chronic hepatitis C.

Methods: A standardized form was used to conduct a retrospective survey from 1999 to 2003 in a French university hospital. All HCV RNA positive in- or outpatients who had not had a liver biopsy or anti-HCV treatment were included.

Improving the organization of consultation departments in university hospitals.

Rationale: Changes in the demography of doctors require changes in care practices.

Objectives: The aim of this study was to identify factors associated with doctors' workload in the ophthalmology consultation department of a university hospital, with a view to developing methods to improve the organization of hospital outpatient clinics.

Methods: A 10-day cross-sectional survey was carried out in an ophthalmology outpatient clinic (in- and outpatient consultations, including emergencies) specializing in the uveitis care.

Parathyroidectomy versus cinacalcet hydrochloride-based medical therapy in the management of hyperparathyroidism in ESRD: a cost utility analysis.

Background: Previously, patients with end-stage renal disease (ESRD) with uncontrolled hyperparathyroidism had few options other than parathyroidectomy, which was reserved for patients refractory to medical therapy. Newer calcimimetic agents, such as cinacalcet, may be an alternative, but raise the possibility of indefinite medical treatment that also would increase costs.

Study Design: Cost utility analysis.

[Mortality-morbidity conferences: evaluation of an intervention to expand their practice in a university hospital].

Background: Mortality-morbidity conferences (M&MC) are a recognized technique for evaluating and improving medical practices as well as improving patient safety.

Objectives: To describe the current practices for identification and management of care-related adverse events and to evaluate the effectiveness of an intervention to promote M&MC in a university hospital.

Methods: The study was designed as a before-and-after survey.

[Improving patient safety: decreasing adverse events associated with medical care].

Awareness of the importance of what were previously called iatrogenic accidents is not new, but recent publications have demonstrated the frequency and severity of the accidents and incidents associated with care, which are now known simply as "adverse events". Research has helped us to understand the principal mechanisms underlying them and the circumstances that promote them. It shows that root causes, often linked to the organization of care, should be sought beneath the initial appearance of mistakes.

Hepatitis B vaccination in women healthcare workers: a seroepidemiological survey.

Objective: To assess the concentration and kinetics of antibody response after hepatitis B vaccination among women healthcare workers.

Design: Longitudinal retrospective seroepidemiological survey among women vaccinated against hepatitis B working in a university hospital and followed-up in an occupational health department. A structured form was used to collect socio-demographic characteristics, clinical data, age at vaccination, vaccination schedule, measurement of antibodies to hepatitis B surface antigen (anti-HBs antibody).

Intra-familial transmission of Helicobacter pylori infection in children of households with multiple generations in Vietnam.

This community-based cross-sectional study in 533 participants from 135 households with multiple generations living in the same household aimed at investigating the relationship between Helicobacter pylori infection in children and the other household members. H. pylori infection in children was found significantly associated with the infection in mothers [OR (95% CI): 2.