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Le Touquet – Paris-Plage, France

Underner M.,Unite de Tabacologie | Peiffer G.,Unite de Tabacologie | Le Houezec J.,Sante Publique | Le Houezec J.,University of Nottingham | And 3 more authors.
Revue des Maladies Respiratoires | Year: 2012

Smoking cessation specialists are frequently confronted with smokers who have great difficulty in stopping smoking, and who are either motivated to stop or are forced to stop for health, economic or statutory reasons. These smokers are composed of a mixed population but they have in common a heavy dependence on tobacco and a significant level of cigarette consumption. They are exposed to serious morbidity induced by their uncontrollable smoking. Other factors unfavourable to the attempt to stop smoking are often present: anxiety-depressive disorders, socioeconomic difficulties or the use of psychoactive substances. They constitute a priority target for smoking cessation clinics, which must optimise and diversify proposals to improve their interventions. This review describes these highly dependent smokers unable to stop, and suggests medical treatments and therapeutic combinations to assist the practitioners trying to help the "hard-core" smokers. © 2012 SPLF.


Lesourd B.,Toulouse University Hospital Center | Juchet A.,Toulouse University Hospital Center | Broue-Chabbert A.,Toulouse University Hospital Center | Colineaux H.,Sante Publique
Revue Francaise d'Allergologie | Year: 2014

Aim: Asthma, the most common chronic disease in pediatrics, has a significant impact on children's lives. The purpose of patient education sessions is to help families in the management of this disease. Here, we will evaluate the sessions available at the School of Asthma in Toulouse in order to make them more efficient. Patients and methods: This assessment was performed by means of two questionnaires (before/after sessions) filled out from November 2011 to December 2012 by 26 children and their families who participated in patient education sessions; these questionnaires were complemented by the patients' medical data. Results: The results showed significant improvement (more than 80%) in the level of asthma control after the sessions as well as a decrease in the number of hospitalizations and emergency consultations. Secondary analyses showed an improvement in crisis management and crisis prevention and a clear improvement of inhalation techniques for all the children. However, the ability of a child to warn an adult and the use of breathing techniques taught in physiotherapy were disappointing, inciting us to develop new strategies. Conclusion: Evaluation of patient education sessions at the School of Asthma in Toulouse showed an improvement in the level of asthma control and inhalation techniques in the children. However, because of the limited power of our study, our results merit to be confirmed by further studies with bigger samples. Finally, we were able to demonstrate the improvement brought about by these sessions. © 2014.


Rieu I.,CHU Clermont Ferrand | Martinez-Martin P.,CIBER ISCIII | Pereira B.,Biostatistics Unit | De Chazeron I.,CHU Clermont Ferrand | And 15 more authors.
Movement Disorders | Year: 2015

The "Ardouin Scale of Behavior in Parkinson's Disease" is a new instrument specifically designed for assessing mood and behavior with a view to quantifying changes related to Parkinson's disease, to dopaminergic medication, and to non-motor fluctuations. This study was aimed at analyzing the psychometric attributes of this scale in patients with Parkinson's disease without dementia. In addition to this scale, the following measures were applied: the Unified Parkinson's Disease Rating Scale, the Montgomery and Asberg Depression Rating Scale, the Lille Apathy Rating Scale, the Bech and Rafaelsen Mania Scale, the Positive and Negative Syndrome Scale, the MacElroy Criteria, the Patrick Carnes criteria, the Hospital Anxiety and Depression Scale, and the Mini-International Neuropsychiatric Interview. Patients (n=260) were recruited at 13 centers across four countries (France, Spain, United Kingdom, and United States). Cronbach's alpha coefficient for domains ranged from 0.69 to 0.78. Regarding test-retest reliability, the kappa coefficient for items was higher than 0.4. For inter-rater reliability, the kappa values were 0.29 to 0.81. Furthermore, most of the items from the Ardouin Scale of Behavior in Parkinson's Disease correlated with the corresponding items of the other scales, depressed mood with the Montgomery and Asberg Depression Rating Scale (ρ=0.82); anxiety with the Hospital Anxiety and Depression Scale-anxiety (ρ=0.56); apathy with the Lille Apathy Rating Scale (ρ=0.60). The Ardouin Scale of Behavior in Parkinson's disease is an acceptable, reproducible, valid, and precise assessment for evaluating changes in behavior in patients with Parkinson's disease without dementia. © 2015 International Parkinson and Movement Disorder Society.


Lensel A.-S.,avenue des gobelins | Lermusiaux P.,HCL Groupement Hospitalier Est | Boileau C.,Sante Publique | Feugier P.,HCL Groupement Hospitalier Est | And 3 more authors.
Journal des Maladies Vasculaires | Year: 2013

Aim: We hypothezised that patients (cases) who are hospitalized for a major ischemic event - myocardial infarction, stroke, decompensation of peripheral arterial disease - acquire better knowledge than a control population - atheromatous patients without a major ischemic event, patients consulting for a vein disease or a diabetes evaluation, and accompanists - about cardiovascular risk factors (smoking, hypertension, diabetes, dyslipidemia, obesity) and have a better understanding of the usefulness of making changes in their lifestyle (quit smoking, regular exercise, Mediterranean diet, low salt diet, weight control, diabetes care). Methods: A questionnaire was proposed at vascular surgery consultations and vascular and cardiac functional explorations, at the M Pavillon of the Édouard-Herriot hospital, Lyon, France. In five months, 395questionnaires (135cases and 260controls) were analyzed. Results: The global knowledge score was statistically higher for cases than for controls (cases 3.23 ± 1.81; controls 2.77 ± 2.03; P= 0.037). Cases did not abide by monitoring and dietary rules better, except as regards the management of diabetes. Regular physical activity was statistically more prevalent among controls than among cases. Cases mainly received their information from their doctors (general practitioner for 59% of controls and 78% of cases, cardiologist for 25% of controls and 57% of cases) while controls got their information more through magazines or advertising. Conclusion: Our results show that after a major ischemic event, cases' knowledge of risk factors is better than the rest of the population without improved rules lifestyle changes. This suggests the usefulness of evaluating a therapeutic education program for atheromatous disease. © 2013 Elsevier Masson SAS.


Bernardy-Prud'Homme A.,Sante Publique | Braillon A.,Sante Publique | Chaine F.-X.,Sante Publique | Bruyelle J.,Sante Publique | And 2 more authors.
Encephale | Year: 2011

Background: Suicide attempt is a serious condition that is frequent in France. Picardie ranks fifth in France for suicide (418 deaths in 2005 for 1 890 000 inhabitants). Suicide attempt is one of the priorities of the regional public health program. The National Agency for Accreditation and Evaluation in Health (Anaes) has designed targeted clinical audits (TCA) on various conditions to promote this method as the basic tool for quality improvement. Aim: We investigated the contribution of TCA for improving the quality of care of suicide attempt within a regional framework in Picardie. Methods: TCA were conducted in 12 state hospitals (eight Surgical Medicine and Obstetrics, three specialized in psychiatry, one local) between 2004 and 2006. The standards from the Anaes had 16 criteria in three fields: care on admission (n = 10); assessment of family and social environment (n = 2); management for after hospital care (n = 4). A project manager and a MD certified in health care quality supported the medical (MD certified in acute care and in psychiatry) and nursing staff of the emergency wards. All the wards analyzed 30 patients' files for the first cycle, set up and implemented improvement actions and then performed the second cycle of data collection. Results: All wards fully satisfied the protocol with 30 patients' files per cycle and two cycles. In all wards the teams consisted of physicians (both certified for emergency or psychiatry) and others care providers (nurses, psychologists, social workers, secretary). For the first cycle, three criteria (patient assessment, somatic examination and coordination) met the 100% target for more than half of the wards while three criteria (sociofamily and environmental evaluation, management for after hospital care, monitoring of follow-up) did not conform by more than 50% in more than half of the wards. All wards implemented changes after the first cycle with a total of 29 interventions, each one specifically devoted to improving a particular criterion. Intervention included better coordination and communication, protocol design and reminders, and information tools. The second cycle showed modest and mixed changes. After the interventions only one criteria reached the 100% target in one ward; the degree of conformity decreased in nine cases (with a mean of -23%) and increased in 16 cases (+19%). Globally, three criteria improved by less than 10% while three slightly decreased. Discussion: G. Shaw introduced clinical audits in 1989 to boost a poorly performing system within the "clinical governance" framework, a condition quite different from the French healthcare system in 2005. Therefore, the validation of clinical audit in a different context appeared necessary. Anaes has not yet published the evaluation of this method in a peer reviewed journal. Observed changes are modest and mixed. Moreover, the true impact on care delivery appears limited and one cannot rule out that the observed improvements are in fact related to an improvement in traceability or due to Hawthorne's effect. Quality improvement methods must be evaluated and validated by scientific methods such as for new treatments with clinical research. Conclusion: The feasibility of the method was excellent, due to the methodological and technical support, however the method did not significantly improve the quality of care. © L'Encéphale, Paris, 2010.

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