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Biomedical subjects

H Maisonneuve

Publications and source records attributed to H Maisonneuve.

At least 19 recordsLinked to original sources
PubMed2006

Website navigation and surgical education.

We evaluated the way in which medical students interacted with a surgical education Website. Ten medical students on their paediatric surgery rotation were asked to study online a chapter on intussusception in young children, for a period of 1 h. The computer was connected by video link to a video-recorder that recorded their navigation movements, i.e. navigation time, time spent in front of each page, stepwise, progressive exploration of the surgical contents, and use of interactive links. The students were asked to complete a questionnaire to identify their overall competency in computers and Internet navigation capabilities. The mean time spent viewing the entire Website was 48 min (range 31-63) and the mean time spent on the assigned chapter was 38 min (range 8-53). Each page out of 14 within the chapter was visited a mean of 1.8 times (range 0-10). Access to video selections occurred after a mean of 10 min after beginning the session. A connection was made to the video a mean of 2.3 times per session. The mean time spent viewing video footage was 9 min (24% of the time spent viewing the chapter). The questionnaire results showed that few students regularly accessed the Internet for educational purposes.

Attitude to Computers↗
PubMed2005

[Defining and assessing competence of healthcare professionals. A survey of 148 organizations].

INTRODUCTION: To study how competence is described and perceived by organizations of healthcare professionals in France and propose approaches toward implementing a policy to monitor and assess competence throughout medical professionals' careers. METHODS: After a literature search, we sent 160 letters to organizations representing 16 healthcare professions (listed in the French healthcare code) describing our objectives and proposing interviews. Semi-structured interviews (45-90 minutes) were conducted. The principle questions asked were: What is your organization's definition of competence? What are the principal elements that define competence in healthcare activities? How can a system for assessing competence be implemented? Which methods for such a system are most appropriate, based on experience in other countries? Who are the players in the field of competence? How can organizations participate in monitoring competence? RESULTS: 265 people representing 148 French organizations were interviewed. Analysis of the interviews showed that the principal points mentioned included: need for recognition; lack of training on new developments; need to anticipate changes; need for better health security in the healthcare system. There was a general consensus on the basic elements of competence, the responsibility of public institutions and professional organizations, and the need to work together. DISCUSSION: We suggest that competence in health care should be defined as follows: "professional competence is based on an initial diploma, participation in effective continuing medical education, a minimum amount of professional activity, and a regular peer review process". Healthcare professionals in France would like to have a better system that allows them to exchange more information on the principal issues in health care.

Clinical Competence↗
PubMed2005

Prospective randomized study comparing MEMID with a chop-like regimen in elderly patients with aggressive non-Hodgkin's lymphoma.

OBJECTIVE: This multicenter phase III study compared the MEMID regimen (mitoxantrone, VP16, methylglyoxal, ifosfamide and dexamethasone) with CEOP, a CHOP-like regimen (cyclophosphamide, epirubicin, vincristine and prednisone), in elderly patients (> or =65 years) with aggressive non-Hodgkin's lymphoma (NHL). METHODS: One hundred and forty-nine patients were eligible, 72 in the MEMID arm and 77 in the CEOP arm. The primary endpoint was to compare overall survival (OS) between groups, and secondary endpoints were event-free survival (EFS), response rate and toxicity. RESULTS: Neutropenia (p < 10(-5)), anemia (p < 10(-5)) and thrombocytopenia (p = 0.0006) were significantly more frequent in patients who received MEMID. We observed an objective response rate of 55.5% in the MEMID arm and 64.9% in the CEOP arm (p = 0.24). The median OS and EFS were 15.4 and 8.5 months in the MEMID arm, and 20.3 and 10.5 months in the CEOP arm (p = 0.59 and 0.47), respectively. The median EFS was 15.4 months in the MEMID arm and 20.3 months in the CEOP arm (p = 0.59). CONCLUSION: The increased toxicity without survival benefit confirms the superiority of CHOP and CHOP-like regimens for elderly patient with aggressive NHL.

Aged↗
PubMed2005

Long-term follow-up of a randomized trial of fludarabine-mitoxantrone, compared with cyclophosphamide, doxorubicin, vindesine, prednisone (CHVP), as first-line treatment of elderly patients with advanced, low-grade non-Hodgkin's lymphoma before the era of monoclonal antibodies.

BACKGROUND: This randomized study compared the efficacy and safety of fludarabine-mitoxantrone (FM) with mini-CHVP (cyclophosphamide, doxorubicin, vindesine, prednisone) in elderly patients with advanced, low-grade non-Hodgkin's lymphoma. PATIENTS AND METHODS: End points were remission rates [overall response (OR) and complete response (CR)], failure-free survival (FFS), survival and toxicity. One hundred and fifty-five patients were randomized, 144 were evaluable for safety and 142 for response. Each treatment arm was given as six monthly cycles, followed by three bimonthly cycles. FM comprised fludarabine (20 mg/m(2) i.v.), days 1-5, plus mitoxantrone (10 mg/m(2) i.v.), day 1. CHVP cycles comprised cyclophosphamide (750 mg/m(2) i.v. infusion), doxorubicin (25 mg/m(2) i.v.) and vindesine (3 mg/m(2) i.v.) on day 1, and prednisone (50 mg/m(2)) on days 1-5. RESULTS: FM therapy resulted in superior remission rates (OR 81% versus 64%, CR 49% versus 17%; P = 0.0004). Median FFS for FM patients was 36 months, compared with 19 months for CHVP patients, and has not yet been reached for early CR patients at 53 months. Treatment arm was the major risk factor influencing survival. Both treatments were well tolerated, with only few infectious complications. CONCLUSION: FM was more effective than CHVP in achieving OR and CR, and favorably affected the outcome.

Age Factors↗
PubMed2005

Authorship ignorance: views of researchers in French clinical settings.

OBJECTIVES: To assess the knowledge and behaviour of researchers regarding criteria for authorship, and the practices of ghost and gift authorship. DESIGN: Semidirective interviews of senior clinical researchers. SETTING: University hospital. PARTICIPANTS: Thirty-nine main investigators of clinical research programmes. MAIN MEASUREMENTS: Awareness and use of International Committee of Medical Journal Editors (ICMJE) criteria for authorship, and perceptions about ghost and gift authorship. RESULTS: A total of 48 protocols submitted by 42 principal investigators between 1994 and 1996 were identified. Thirty-nine investigators were contacted; 37 (one of whom delegated a co-author) were interviewed between May 2002 and March 2003. Two co-authors of two principal investigators were also interviewed. In all, 42 studies were represented. The interviews lasted for 40-90 minutes and were conducted with openness and respect for confidentiality. The choice of names of co-authors did not follow the ICMJE recommendations. Half of the respondents stated they were aware of criteria for authorship and knew of ICMJE, but most of them did not cite any of the ICMJE criteria among those they applied in deciding authorship. Most of them disagreed with the obligation to meet the three criteria justifying co-authorship because they found these too rigid and inapplicable. Gift authorship was a common practice; 59% of the respondents had been a recipient of gift authorship. Twenty-five (64%) were aware of ghost authorship and the majority considered it questionable and blameworthy. CONCLUSIONS: The ICMJE criteria were ignored by clinicians at a university hospital. Ghost and gift authorship were frequent among them. There is a need for French guidelines for authorship to be prepared and implemented.

Adult↗
PubMed2001

Evaluation of 60 continuous quality improvement projects in French hospitals.

OBJECTIVE: To evaluate the feasibility of implementing continuous quality improvement (CQI) projects in French health care organizations. DESIGN: The French Ministry of Health issued two calls for CQI projects (in 1995 and 1996). ANAES was commissioned to monitor and evaluate the projects, and to provide advice. SETTING: ANAES in collaboration with French public hospitals. STUDY PARTICIPANTS: A jury selected 64 projects from 483 submissions. The first series of projects related to safety issues (e.g. blood transfusions), the second related chiefly to patient management. INTERVENTIONS: ANAES instructed project leaders in process analysis (modified four-step FOCUS-PDCA model), convened regular meetings between leaders and performed on-site visits. MAIN OUTCOME MEASUREMENTS: Objective outcomes: goal achievement, extension of projects to other topics and departments, allocation of resources. Subjective outcomes: changes in attitudes. Statistics were obtained from two questionnaires completed by project leaders. RESULTS: Four projects were discontinued; 82% (49 out of 60) met more than half their objectives. The CQI method was adopted by other departments in 65% and 50% (1st and 2nd series respectively) of cases. Hospital management often chose to provide continued support (81%/88%), offer training (59%/80%), create a CQI unit (62%/73%), and allocate a budget (61%/65%). A positive impact on staff attitudes was noted in over 75% of projects. CONCLUSION: ANAES' co-ordinated initiative to acquaint a hard core of French public hospitals with CQI proved successful. Identification of the factors for success and of potential hurdles helped pave the way for the national hospital accreditation procedure currently underway.

Attitude of Health Personnel↗
PubMed2000

[Good clinical practice in using antibiotics in the hospital. Current status in 207 public and private hospitals in 1999].

OBJECTIVES: The purpose of this study was to map activities developed in hospitals to monitor antibiotic usage and evaluate implementation of French guidelines for good clinical practice on use of antibiotics in the hospital setting. METHODS: A questionnaire was mailed to the head of the pharmacy of 300 French hospitals. The questionnaire targeted methods developed to monitor antibiotic usage (antibiotic committees, local recommendations, types of prescription and dispensing, surveillance, information and evaluation activities). RESULTS: The response rate was 69% (207 answers). A local committee supervised antibiotic usage in 49% of the hospitals (nosocomial, drug or antibiotic committees). Local recommendations existed in 120 hospitals (59%) and 42% of the hospitals had a validation process before dispensing drug in accordance with the recommendations. Antibiotic prescription was nominal in 65% of the hospitals and specific monitoring was carried out in 42% of them. Antibiotic consumption was monitored in 80% of the hospitals and resistance was monitored in 53%. Twelve percent of the hospitals used an electronic network to share information on prescription and bacteriological results. Regular internal training existed in 20% of the hospitals and evaluation methods (medical audits, impact measures) in 14%. DISCUSSION: Careful monitoring of antibiotics is implemented in most hospitals. Strict application of guidelines, definition and implementation of indicators, and evaluation methods must be improved. Implementation of better hospital monitoring of antibiotics requires: i) a local consensus to limit the antibiotics available and guidelines to adapt to local infections; ii) dissemination of guidelines and training for prescribers; iii) implementation of a dispensing system to check the validity of prescriptions according to local guidelines; iv) implementation of indicators to monitor bacterial resistance and the volume of antibiotics used.

Anti-Bacterial Agents↗
PubMed2000

Cardiac pacemakers. When clinical evaluation lags behind technological progress.

OBJECTIVE: The rise in the number of implantations of cardiac pacemakers is of some concern to decision makers in the health sector. We assessed the intrinsic and relative clinical efficacy of cardiac pacemakers in current clinical indications to find out whether scientific or clinical arguments might justify differences in market prices. METHODS: We retrieved papers on cardiac pacing (January 1993-April 1998) from five databases (MEDLINE, HealthSTAR, EMBASE, Cochrane Library, and PASCAL). The citations in these papers were used to seek further articles. We selected the articles that met the criteria of evidence-based medicine (EBM) (randomized and nonrandomized controlled trials) and classified them according to clinical indication and type of evaluation (either of the intrinsic efficacy of a pacemaker versus a control or of the relative efficacy of different pacing modes). RESULTS: A total of 542 references were retrieved, but under 10% met our EBM criteria. Very few were comparative studies versus controls; most were recent and tended to use endpoints other than survival. Clinical efficacy was not proven on the basis of EBM criteria, even in common indications (e.g., sick sinus syndrome). Studies comparing different pacing modes were rarely randomized and did not provide consistent evidence for the superiority of any pacing mode in a given indication. CONCLUSIONS: Knowledge of the natural history of the diseases for which cardiac pacing is indicated is scarce. There is an approximately 20-year gap between technological progress and clinical evaluation that cannot be easily bridged because of methodologic difficulties and ethical issues. Current guidelines on pacemaker use either rely on expert opinion or highlight present inadequacies and make recommendations for future work. Available clinical efficacy data do not justify the wide differences in the price of cardiac pacemakers.

Evidence-Based Medicine↗
PubMed2000

[Abdominal aortic aneurysm repair treated with endoprosthesis: technical and economic evaluation by ANAES(National Agency of Health Accreditation and Evaluation)].

OBJECTIVE: To evaluate the safety, efficacy and cost of stent-grafts for the endovascular repair of abdominal aortic aneurysms (AAA). MATERIALS AND METHODS: The ANAES report was based on a critical analysis of the published international literature and on consultation of technology assessment agencies. The report was reviewed by a group of experts and validated by the ANAES Scientific Council (Evaluation Section). RESULTS: The literature analysis indicated that the technique was feasible. However, it also revealed a shortage of methodologically sound clinical trials. The long-term outcome of the stent-grafts and the accompanying complications are not yet known. CONCLUSION: Further clinical studies are needed for a truly objective assessment. The ANAES working group has issued a series of recommendations designed to help physicians define the optimal conditions for the effective and safe use of these stent-grafts.

Aortic Aneurysm, Abdominal↗
PubMed1999

From the life-cycles of clinical evidence to the learning curve of clinical experience.

Treatments on offer to an individual with suspected disease are based on concepts which, like products, go through life-cycles (introduction, growth, maturity, decline). We argue that randomized controlled trials, meta-analyses, and guidelines have reached maturity and/or are already on the decline and note renewed interest in case reports and qualitative medicine. The latter emphasize individual rather than 'average' patients. Moreover, we point out that scientific evidence relates not only to variables that can be measured but also to categorical variables that are often neglected. An appropriate treatment strategy is probably one which is indicated by several methods based on different concepts rather than by a single standard method. The doctor's role is to use his critical judgement and experience to appraise evidence from formal trials and from analyses of observational data and to share his views with the patient.

Clinical Protocols↗
PubMed1998

Ovarian transposition by laparoscopy before radiotherapy in the treatment of Hodgkin's disease.

BACKGROUND: The use of inverted Y irradiation in the treatment of Hodgkin's disease with pelvic lymph node involvement can cause iatrogenic early menopause in young women as a result of ovarian exposure to radiation. Ovarian transposition protects the ovaries by removing them from the irradiation field. This surgical procedure, initially performed by laparotomy, can now be done by laparoscopy. METHODS: During the period July 1994 to April 1996, laparoscopic ovarian transposition was performed on 4 young women with Hodgkin's disease 1 week before inverted Y radiotherapy. The surgical procedure, complications, length of hospitalization, and hormonal, clinical, and biologic results were evaluated. RESULTS: The mean duration of hospitalization was 4 days, and there were no postoperative complications. Iatrogenic menopause did not occur in any of the patients during the mean follow-up period of 20.75 months (range, 6-35 months; median, 20 months). CONCLUSIONS: Laparoscopy offers many advantages over laparotomy for ovarian transposition. This procedure, which can be performed without opening the abdominal wall, is highly efficient, requires only a short period of hospitalization, and leads to few postoperative complications. Laparoscopy is an attractive alternative to laparotomy for ovarian transposition in young women with advanced Hodgkin's disease who require pelvic radiotherapy.

Adult↗
PubMed1998

[Different forms of writing in medical journals].

The author describes the editorial rules of the different forms of articles published in medical journals: editorial, original article, review article, clinical observation, letter, clinicopathological discussion, pedagogic article. The majority of these forms of articles must follow a simple plan of writing ("the IMReD plan"), including introduction (why I did this study?), methods (how I did this study?), results (what were my observations?) and discussion (what do I think about these results?).

Medicine↗