Biomedical subjects
Publications and source records attributed to S Pontone.
Authors refer about their experience on treatment of symptomatic diverticular disease both with antibiotic and anti-inflammatory drugs. They confirm the observation of other Authors on effectiveness of this new therapeutic approach versus traditional antibiotic therapy.
STUDY DESIGN: The aim of this study was to assess how French anaesthesiologists perform continuing medical education (CME). METHODS: A 73 items survey was mailed to 1,000 anaesthesiologists (11% of anaesthesiologists population) of geographic, gender and institution representative of national anaesthesiologist demography. A second mail was sent to non-responders, 6 weeks later. RESULTS: The answer rate was 40.8% and the sample of responders appeared to match the French anaesthesiologist population. Seventy-two percent of surveyed anaesthesiologists were affiliated to the French society of anaesthesia-intensive care and 24% to other medical societies. Attendance to French congresses was 81% and miscellaneous congresses were equally appreciated in terms of quality. Only 17% of surveyed anaesthesiologists attended international congresses. Multi-thematic congresses were preferred by 67%. The annual time devoted to congresses was 6 days (median) with additional 4 days (median) reserved for practical courses. French medical journals and international journals had a reading rate of 89 and 37%, respectively. For 61% of responders CME was funded by institutional grants. Internet CME use was found in 73% of anaesthesiologists. Time and money were the two most frequent reasons invoked for CME restriction. CONCLUSION: CME is a broadly shared activity, which still remains focussed on national resources.
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BACKGROUND AND OBJECTIVE: The perception of a looming manpower shortage led the French College of Anaesthesiologists (CFAR) and the French Society of Anaesthesia and Intensive Care (SFAR), with assistance from the National Institute for Demographic Studies (INED), to conduct a national survey of French anaesthesiologists in order to determine precise physician characteristics data, analyse professional practices and project future service provision. METHODS: The survey was based on self-administered individual questionnaires, approved by the National Committee on Informatics and Freedom (CNIL). The survey was carried out at the end of 1998 among 1484 hospitals (590 public and 894 private), under the supervision of local referees and regional co-ordinators. RESULTS: Of 9741 anaesthesiologists' posts, 5694 (58%) are in public hospitals, 3569 (37%) in private practice and 478 (5%) in private hospitals within the National Health Service, i.e. the participant au service public hospitalier (PSPH). Complex validation of the results was necessary to account for the missing responses and multiple sites of activity. The survey identified 8876 specialists practising anaesthesia and intensive care in France at the beginning of 1999, including 216 in French overseas territories. This figure is consistent with that published by the Medical Council (Ordre des Médecins) on 1 January 1999, identifying 8950 anaesthesiologists in France, including 234 in the overseas territories. Annual growth in the anaesthesiologist population has fallen from 9% pre-1989 to 0% in 1999. Male anaesthesiologists outnumber females (35.7%). The average age has risen from 42.8 yr in 1989 to 45.9yr in 1999. The age distribution of anaesthesiologists has become bell shaped, reflecting reduced numbers of younger practitioners. There are currently 14.75 anaesthesiologists per 100 000 people (compared to 12.9 in 1989), a figure slightly above the European average, but there is considerable geographical inequality between the north and south of France, with increased concentrations in large cities that contain university hospitals. CONCLUSIONS: Future service provision must take account of falling numbers of new anaesthesiologists and an increase in retirements, but must also include changes in working practices, such as the European Working Time Directive. If anaesthesia manpower shortages are to be avoided, there must be a restructuring of the work-place, a redefinition of tasks and improved management of working time.
Considering the important role of Helicobacter Pylori (Hp) in the most common gastro-intestinal pathologies, the Authors want to test the effectiveness of a non-invasive diagnostic technique for detection of the Hp in the gastric mucosa. At the end of experience they think, like the most of Literature, that the Breath Test, concerning sensibility and specificity, represent the gold standard for detection of the Hp.
OBJECTIVES: Fears related to the future of anaesthesia manpower in France have led the French College of Anaesthesiologists (Cfar) and the French Society of Anaesthesia and Intensive Care (Sfar), in scientific partnership with the National Institute for Demographic Studies (Ined), to set-up a national survey among French anaesthetists (MAR) practicing in France, to describe their demographic evolution and to analyse their professional activities. METHODS: The survey was based on a personal questionnaire, filled by each individual, approved by the National Commission on Informatics and Freedoms (CNIL). The survey was conducted in November 1998, in the 1484 hospitals, public (590) and private (894) where anaesthetics are performed, under the control of local and regional referents. RESULTS: The anaesthesiologists positions count gave a total of 9741 positions shared between 5694 in public practice (58%), 3569 in private practice (37%) and 478 in private hospitals taking part to the national health service-PSPH (5%). The evaluation of the number of anaesthesiologists from the number of positions has made necessary a methodology of rectification of the survey to take in account the lack of response and the multiple sites of activity. The survey allows an evaluation of around 8876 physicians practising anaesthesia and intensive care in France at the beginning of 1999, among them 216 overseas. This census is in concordance with the count made by the Medical Council--Ordre des médecins--which published a number of 8716 anaesthesiologists in France, and 234 overseas, at the 1st January 1999, corresponding to a total of 8950. The annual demographic growth has felt from 9% per year, before 1989, to reach the level zero, in 1999. The masculinisation of the speciality is growing with a proportion of 35.7% of females, as well as ageing, the overage of age increasing from 42.8 in 1989 to 45.9 years in 1999. The pyramid of ages does not correspond to a growing population but to ageing people due to a decrease of the youngest classes. The medical density of 14.75 anaesthesiologists for 100,000 inhabitants in 1999, compared to 12.9 in 1989, is slightly above the European average, but the geographic distribution is very unequal between north and south, the large cities, centre of a university hospital, and the smaller one even if a reduction of differences is observed. The study and the analysis of professional activities bring important data to take in account side of demographic evolution. CONCLUSION: The demographic evolution must integrate non-only the reduction of the entries in the speciality, of the retirements, but also the sociological evolutions linked to the working time reduction. The solutions face to the promised shortcut of manpower consist of a reorganisation of the structures, a new definition of tasks and managements, without the possibility to avoid and adjustment of the anaesthesiologists population.
Aim of this study was to compare virtual and conventional colonoscopy for the detection of colon-rectal polyps. The authors studied 20 patients with these two methods and it was found that virtual colonoscopy is dependent on the size of lesions regarding sensitivity and specificity, is expensive and the learning process with reading images is very long.
For now the most used pharmacological treatment of first instance to eradication of Hp foresees utilization of triple therapy (PPI + two antibiotics). In our study we have compared this kind of treatment with the quadruple therapy (PPI + three antibiotics), that have showed a taller percentage of eradication at the end of first therapeutical cycle with a shorter time and lower price of treatment.
Now, draining the cholestasis by endoscopic way is a safe and effective solution. The most of Authors think that the non neoplastic cholestasis find her substantial solution by endoscopic methodology. We reported the most important endoscopic techniques used in these cases, especially the papillosphincterotomy, the pneumatic dilatation and the placing of endoprosthesis.
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Due to a drastic decrease, by governmental regulations, of the number of trainees in medical specialties, only 113 anaesthesiologists have been trained annually from 1988 to 1998, versus 440 annually from 1978 to 1988. If this training rate remains unchanged the manpower will decrease in 2010 to the 1980 level. In the opposite, the number of anaesthetics increased from 3.5 millions in 1980 to about 8 millions in 1996. If governmental health care policy remains unchanged, a major shortage of anaesthesiologists is to be expected from 2010 on. This shortage will occur earlier if anaesthesiologists retire before the age of 65 years.
In order to assess the medical activity and the related costs, the French Ministry of Health has designed a relative value scale for medical procedures, the Relative Complexity Index (RCI). The RCI for anaesthesiology, called BETA, is the result of the combination of four subindexes: T for the type of anaesthesia, D for the duration, C for the related surgical procedure, and EG for the patient's status according to the ASA scale. The goal of this study has been to test whether the BETA index was actually an acceptable indicator of the direct cost of an anaesthetic. We have determined the cost of 248 procedures in a teaching hospital and achieved a statistical analysis of the relationship between costs, RCI and the various subindexes. The mean cost of an anaesthetic was 1,205 FF (SD = 1,325), 61.4% of which being for salaries. The cost of a general anaesthetic was 2.5 times higher than the cost of a local/regional anaesthesia procedure. Mean cost was around 700 FF for ENT, urology, gynaecology and obstetrics, 1,200 FF for orthopaedia and visceral surgery, and 5,130 FF for cardiac surgery (not including the equipment for extracorporeal circulation). A strong positive relation was found between the BETA and cost (r = 0.90, p < 10(-4)). The best predictive model of cost was log-linear, using only the duration, the type of anaesthetic and the related surgical procedure. The patient's status was not a significant factor, nevertheless in our sample, ASA 4 patients had a significantly higher cost than others (p = 0.0004, Mann & Whitney test).(ABSTRACT TRUNCATED AT 250 WORDS)
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Authors report their experience in the treatment of adenomas with severe dysplasia and early cancer of the colon-rectum confirming that the endoscopic resection of these lesions is safe and curative when completely removed and no submucosal invasion is found. Between 1995 and 1999, 219 patients underwent colonoscopy and 287 polyps were removed. Histologic examination showed 217 adenomatous polyps (75.6%), 58 non adenomatous (20.2%) and 12 early carcinomas (4.2%). Severe dysplasia was found in 15 adenomas. There were no complications. The Authors focused on 12 patient with early carcinoma and 15 with severe dysplasia. The mean follow-up was 34 months. No recurrences were observed, supporting that this procedure is the treatment of choice in selected cases.
Many studies emphasize the right indications about the execution of an EGDS showing that a lot of requests are inappropriate. We have wanted to report our experience too, that showed more comfortable results than that checked, by other Authors moreover we have emphasized that the inappropriate requestsare justly divided between generical and specialized physicians.
The utilization of stents in neoplastic colon pathology finds a correct location in the therapeutic panorama. Authors report the use of enteric stents as definitive treatment in acute intestinal occlusion with inoperable malignant neoplasia as well as palliative treatment in intestinal occlusion with non-surgically resectable neoplasia.