Device-vigilance at university hospital in central eastern tunisia: A survey conducted among physicians [La matério-vigilance dans un centre hospitalo-universitaire du centre-est tunisien: Enquête auprès des médecins]
Mahjoub M.,Service Dhygiene Hospitaliere |
Jedidi M.,Service de Medecine Legale |
Masmoudi T.,Service de Medecine Legale |
Bouafia N.,Service Dhygiene Hospitaliere |
Njah M.,Service Dhygiene Hospitaliere
Pan African Medical Journal | Year: 2016
Introduction: the University Hospital Farhat Hached Sousse (Tunisia), has implemented a device-vigilance (DV) system, according to ANCSEP (National Agency of the Sanitary and Environmental Control of Products) guidelines, in order to manage the risk more effectively in hospital and to improve the quality and safety of patient care. In Tunisia the lack of regulation regarding device vigilance is the major obstacle to caregiver vigilance. The objective of this study is to establish the knowledge, attitudes, and clinical practice of University Hospital physicians regarding the implementation of the DV system. Methods: we conducted a descriptive cross-sectional study of KAP (knowledge, attitudes and practices) among all the physicians working at the University Hospital Farhat Hached Sousse (Tunisia) who were users of medical devices (MDs) in the practice of their profession. A self-administered, pre-established and pre-testing questionnaire was developed. Data were collected and analyzed using SPSS20.0 software. Results: the response rate was 51.9 % (183/95). A lack of knowledge about DV has been reported. More than half of the respondents didn’t know the local correspondent of health establishment and the existence of a standardized vigilance reporting form. Regarding the attitudes, 89,5% express their interest in setting up a DV system and 37,5% acknowledged that the vigilance reporting form should be filled by the caregiver notifying the incident. Regarding the procedures, the majority of physicians confirmed the absence of an organized maintenance management of the MDs in the practice of their services. 90.5% express their wishes to receive information but few of them express their wishes to receive proper training (57.9%). Conclusion: a lack of information and training in a sensitive field which need to be heavily regulated has been a topic of discussion. The promulgation of regulatory texts is necessary in order to promote MD sector and guarantee the safety of patient and their users. © Mohamed Mahjoub et al.
PubMed | Service dimagerie pediatrique et prenatale, Aix - Marseille University, Service de medecine legale and Center Pluridisciplinaire Of Diagnostic Prenatal
Type: Journal Article | Journal: Gynecologie, obstetrique & fertilite | Year: 2015
The fields of application of post-mortem imaging have been exponentially growing for 10years. Its potential to identify the cause of death in trauma and ballistic cases is now properly documented. In pediatric and perinatal practice, large significant series are less available, except for MRI and central nervous system analysis where scientific evidence is now robust. After a short historical and state-of-the-art review, we will try to depict the way we see the future of this sub-specialty of post-mortem imaging, especially in specific perinatal situations.
Lalys L.,French National Center for Scientific Research |
Pineau J.-C.,French National Center for Scientific Research |
Serre T.,INRETS |
Bartoli C.,Service de Medecine Legale |
Leonetti G.,Service de Medecine Legale
Comptes Rendus - Biologies | Year: 2012
This study covers a fifty-year period between 1953 and 2005 and looks at secular trends in stature, weight and sitting height sizes among French boys and girls between the ages of 3 and 11. A special modelling in function to the age and variable for each child was established so that a comparison could be made in the kinetic growth patterns over these same two periods. Statistical analysis shows a significant increase in growth, of 0.8 cm per decade in stature, characterised by a certain increase in the lower limbs and the weight (0.8 kg per decade) together with a proportional increase on the body mass index. Positive secular trends of this anthropometric nature are generally thanks to improved eating and sanitary habits and this study enables us to build and elaborate new standards in growth patterns essential for monitoring auxological development in 3 to 11-year-old children in the years 2000 and onwards. © 2011 Académie des sciences. Published by Elsevier Masson SAS. All rights reserved.
Mazoyer C.,Laboratoire LAT LUMTOX |
Carlier J.,Laboratoire LAT LUMTOX |
Boucher A.,Center Devaluation Et Dinformation Sur La Pharmacodependance Of Lyon |
Peoc'h M.,Service de Medecine Legale |
And 2 more authors.
Journal of Forensic Sciences | Year: 2013
We report the case of a man who died twelve hours after ingesting powdered iboga root, commonly taken for its stimulant and hallucinogenic properties. Ibogaine and ibogamine were quantified in the powder ingested and the victim's body fluids by GC-MS/MS after liquid-liquid extraction (Toxi-tubes A®). The concentrations of ibogaine measured in the blood samples taken at the scene and in the peripheral blood, urine, and gastric fluid samples taken during the autopsy were 0.65, 1.27, 1.7, and 53.5 μg/mL, while the iboga content in the powder was 7.2%. Moreover, systematic toxicological analyses of biological samples showed the presence of diazepam and methadone in therapeutic concentrations. Death was attributed to the ingestion of a substantial quantity of iboga in the context of simultaneous methadone and diazepam consumption. © 2013 American Academy of Forensic Sciences.
Complexity in Therapeutic Patient Education illustrated through two examples: Multimorbidity, and brief intervention in police custody [Complexité et éducation thérapeutique. Exemples de la polypathologie chronique et de lintervention brève multiple en garde à vue]
Lefevre T.,Service de medecine legale |
Lefevre T.,University of Paris 13
Medecine des Maladies Metaboliques | Year: 2016
Complexity is a concept that could help renovate the biomedical model of health. The therapeutic patient education (TPE) or the self-management is a practice that can change the way we imagine the health care system and integrate the psychosocial dimensions to the current biomedical model of health. TPE should consider the ideas and techniques deriving from the sciences of complexity. Indeed, the classical statistical techniques are not appropriate to take into account real life specificities or multifactorial processes. We present here two distinct examples of TPE in which complexity naturally rises: in patients with multimorbidity, and in patients examined in custody settings. We also present several available techniques that preserve complexity. © 2016 Elsevier Masson SAS
Shojai R.,Marseille University Hospital Center |
Bretelle F.,Marseille University Hospital Center |
D'Ercole C.,Marseille University Hospital Center |
Boubli L.,Marseille University Hospital Center |
Piercecchi M.-D.,Service de Medecine Legale
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2013
Objectives: To analyse the nature of medico-legal claims in a high-risk speciality. Materials and methods: Retrospective review of the causes of medico-legal disputes at the department of Obstetrics and Gynaecology of the North University Hospital of Marseilles between November 1997 and December 2010. Disputes were defined by complaints, judicial or conciliatory claims and intentional declaration of potential medico-legal case by physicians. Results: Fifty-nine controversial medico-legal cases were identified within this 13-year period. Ninety percent (n = 53) of cases concerned obstetrics and 10% (n = 6) gynaecology. The rate of litigations tripled in a decade. Half of the litigations led to judicial or conciliatory expertise. The average rate of malpractice litigations was 2.4 per physician. Uterine rupture was the most common cause of complaints. Conclusion: Increased awareness of the nature of litigations may help elaborate risk reduction management programs in order to reduce professional liability on the long run. © 2012 Elsevier Masson SAS. All rights reserved.
Dorandeu A.,Service de medecine legale |
Lorin de la Grandmaison G.,Service danatomie pathologique et de medecine legale
Annales de Pathologie | Year: 2013
The assessment of post-mortem interval is of major importance in forensic pathology. Many methods have been used in the early post-mortem period but remain rough. To test the hypothesis of an increased rate of apoptosis increasing with post-mortem interval, TUNEL method was applied in rats to study the relationship between the number of apoptotic cells in skin samples and the post-mortem interval. Our study showed that the post-mortem processes were associated with apoptosis in skin cells. The apoptosis rate was statistically correlated with post-mortem interval in the early post-mortem (less than 48. hours after death). The application of the TUNEL method for estimating the post-mortem interval in forensic pathology is discussed. © 2012 Elsevier Masson SAS.
PubMed | University of Edinburgh, Service de Medecine Legale and Montpellier University Hospital Center
Type: | Journal: Forensic science international | Year: 2014
This paper presents the principles and results of TSP (the two step procedure), a comprehensive (combined) method of age estimation in mature human skeletal remains. The first step consists of the examination of the pubic symphysis using the Suchey-Brooks system for a pre-choice. Then for SBS phases I, II, III, (young adults up to about 40) the age estimate is given using the chronological interval corresponding to each phase. For SBS phase is IV, V or VI (mature adults, about 40 to 60), then (second step) the dental method of Lamendin (using single rooted tooth) will be applied alone. Both methods are fast, easy to learn and to use (requiring no preparation except cleaning soft tissues from the pubic bone) and are not expensive, making TSP usable by all pathologists or anthropologists in any Forensic unit. It is also of great practical use in mass disaster and mass grave situation. After 15 years of use, a literature review and four evaluation studies we confirm that TSP is more accurate than any single method for aging adults and at least as good as more complicated combined methods. Despite its advantages TSP is, like all other aging methods, not efficient in adults over 65 years of age.
PubMed | Paris 8 University, French Institute of Health and Medical Research, Service de medecine legale and University of Versailles
Type: Journal Article | Journal: Revue d'epidemiologie et de sante publique | Year: 2016
New Caledonia has one of the highest global rates of death from road accidents: 240 deaths per million inhabitants in 2011 with a majority of young people. However, research on driving behaviors has remained rare.A cross-sectional survey based on face-to-face questionnaire with 1400 male and female youth aged 16 to 25 was conducted in 2007. It was used to measure the frequency of accidents and to compute a score of driving behaviors and their associations with socio-demographic characteristics, lifestyles as well as other health behaviors. RESULTS-A total of 10.6% of boys and 6.5% of girls reported a car accident in the previous twelve months period. Among male participants risky driving behavior was associated with having a degree (ORa=2, 95% CI [1.1-3.8]), sport practices (ORa=3.7, 95% CI [1.9-7.05]), involvement in a fight in the last twelve months (ORa=2.2, 95% CI [1.4-3.4]) and precocity of cannabis use (ORa=1.8, 95% CI [1.2-2.8]). Youth living in couple and those with children presented with higher risk-taking scores. Among female participants, young age at cannabis initiation (ORa=3.1, 95% CI [1.5-6.4]) and at sexual debut (ORa=2.4, 95% CI [1.1-5.1]) were associated with driving risk-taking. Finally, younger age at first alcohol intoxication was associated with risky behavior on the road in both sexes. These results highlighted the multidimensional nature of risk-taking behaviors on the road and showed that they are part of, for boys and girls, a larger pattern of risky behaviors. Such results suggest to include behaviors on the road in a comprehensive approach of prevention.
PubMed | Center Hospitalier Sud Francilien and Service de Medecine Legale
Type: Journal Article | Journal: International archives of occupational and environmental health | Year: 2016
To test for differences in somatic, psychic and functioning outcomes associated with assaults across four groups of workers, of which three are structurally at high risk of occupational violence. To report and compare job characteristics, characteristics of the assault and medical findings in police officers and other workers at the time of a forensic examination performed shortly after they complained for being assaulted while working.A two-centre prospective study recruiting adult survivors of workplace violence who lodged a complaint to the judicial authorities and were examined by forensic physicians in the Paris area, between 2010 and 2012 over a 27-month period, was conducted. Victims were administered a dedicated questionnaire and filled in the peritraumatic dissociative experiences questionnaire. Bivariate and multivariate analyses were performed on collected data to account for potential biases.Compared to employees of public transports services, private security guards and other workers, police officers were less likely to report psychic disturbances and peritraumatic dissociative experiences, despite adverse factors such as a worse external working climate or more frequent exposure to workplace assaults. No differences were observed in terms of somatic symptoms or functional impairment across groups.Although structurally more exposed to adverse factors than other workers, police officers appeared to be more protected from negative outcomes. The reasons for this resilience should be more precisely investigated.