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Niaré D, Debin M, Merdrignac L, Blanchon T, Hanslik T, Steichen O. [Prevention of pertussis in newborns: Should pregnant women be vaccinated at each pregnancy?]. Rev Med Interne 2023; 44:567-570. [PMID: 37400278 DOI: 10.1016/j.revmed.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
Pertussis is a respiratory disease that can be fatal at all ages but especially in infants before their mandatory vaccination. Recent epidemiological data shows a decrease in the number of pertussis cases, but a resurgence cannot be excluded in the coming years due to the cyclic evolution of the disease and the loosening of hygiene measures. Two approaches are used to protect infants before their vaccination: vaccination of the mother during pregnancy and vaccination of all the infant's close relatives (cocooning). The vaccination of the mother during pregnancy is more effective. The uncertain risk of chorioamniotitis associated with vaccination during pregnancy is insufficient to question this strategy.
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Affiliation(s)
- D Niaré
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012 Paris, France.
| | - M Debin
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012 Paris, France
| | - L Merdrignac
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012 Paris, France; Epiconcept, Paris, France
| | - T Blanchon
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012 Paris, France
| | - T Hanslik
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012 Paris, France; Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, AP-HP, 92100 Boulogne-Billancourt, France; UFR des sciences de la santé Simone-Veil, Université de Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
| | - O Steichen
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012 Paris, France; Service de médecine interne, hôpital Tenon, Assistance publique-Hôpitaux de Paris, AP-HP, 75020 Paris, France; Sorbonne Université, Faculté de médecine, Paris, France
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Caboche-Salouhi P, Le Seac'h A, Lionnet F, Santin A, Mattioni S, Tamboura F, Steichen O, Barbaud A, Senet P. "SCULP" study: The benefits of skin graft pellets on the pain of sickle cell leg ulcers (SCLU). J Med Vasc 2023; 48:100-104. [PMID: 37914454 DOI: 10.1016/j.jdmv.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Leg ulcers associated with major sickle cell disease (SCLU) are a chronic, painful complication, often treated by autologous skin graft. The analgesic effect of skin grafting in SCLU is poorly studied. The aim of this study was to evaluate the effect of skin grafting on the pain and healing of SCLU. METHODS Patients hospitalized for SCLU skin grafting were included in a retrospective and prospective observational cohort, between 2019 and 2023: 53 autologous pinch grafts were performed on a total of 35 SCLUs in 25 sickle cell patients. The primary endpoint was the evaluation of the analgesic effect of the skin graft, measured by visual analog scale (VAS) and weekly cumulative analgesic consumption between day (D)0, D7 and D30. Wound healing was assessed by variation in wound areas between D0 and D30. RESULTS Twenty-five patients with a median age range of 45.5years old were included, 68% were men, SS genotype was present in 96% of the cases. At D7, a significant decrease in VAS and consumption of analgesics of all classes was observed. At D30, only a significant decrease in VAS and consumption of mild opioids was present, as well as a significant reduction in wound surface area compared with D0. CONCLUSION Pinch grafts have a significant early analgesic effect in the management of patients with SCLU, and significantly notice reduction of wound surface area within one month.
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Affiliation(s)
- P Caboche-Salouhi
- Paris Cité University, Faculty of Medicine, Paris, France; Dermatology-Allergology and Vascular Medicine Department, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - A Le Seac'h
- Dermatology-Allergology and Vascular Medicine Department, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France; Sorbonne University, Faculty of Medicine, Paris, France
| | - F Lionnet
- Department of Internal Medicine, Sickle Cell Reference Center, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Santin
- Department of Internal Medicine, Sickle Cell Reference Center, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France
| | - S Mattioni
- Department of Internal Medicine, Sickle Cell Reference Center, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France
| | - F Tamboura
- Dermatology-Allergology and Vascular Medicine Department, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France
| | - O Steichen
- Sorbonne University, Faculty of Medicine, Paris, France; Department of Internal Medicine, Sickle Cell Reference Center, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Barbaud
- Dermatology-Allergology and Vascular Medicine Department, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France; Sorbonne University, Faculty of Medicine, Paris, France
| | - P Senet
- Dermatology-Allergology and Vascular Medicine Department, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France
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Steichen O. [Hypertension: Who to treat, to what extent and how?]. Rev Med Interne 2023; 44:158-163. [PMID: 36710087 DOI: 10.1016/j.revmed.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/18/2022] [Accepted: 01/08/2023] [Indexed: 01/30/2023]
Abstract
Hypertension is the modifiable risk factor causing the largest loss in healthy life-years. The risk of cardiovascular events increases exponentially with the level of blood pressure (BP), starting from 115mmHg for systolic BP. Out-of-office BP measurements (self-measurements or ambulatory BP measurements) are now preferred for the diagnosis and follow up. In the absence of a preferred indication, antihypertensive treatment is based on thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. These treatments are associated with a significant reduction in morbidity and mortality in people with office BP ≥ 140/90mmHg (self-measurements ≥ 135/85mmHg). For people at high cardiovascular risk, especially those with a history of cardiovascular disease, starting the treatment for an office BP ≥ 130/80mmHg is also beneficial (self-measurements ≥ 130/80mmHg as well). It is now common to start treatment with half-dose dual therapy, which is more effective and better tolerated than full-dose monotherapy. The clinical effect is assessed at 4 weeks and intensification, if required, is then usually done by switching to the same dual therapy at full-dose for both components.
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Affiliation(s)
- O Steichen
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, équipe Sentinelles, 75012 Paris, France; Assistance publique-Hôpitaux de Paris (AP-HP), Sorbonne université, CHU de Tenon, service de médecine interne, 4, rue de la Chine, 75020 Paris, France.
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Azoyan L, Lombardi Y, Renaud MC, Duguet A, Georgin-Lavialle S, Cohen-Aubart F, Ibanez G, Steichen O. [Association between students' clinical performance and their success in the computerized national ranking tests: A single-center retrospective cohort study]. Rev Med Interne 2023; 44:5-11. [PMID: 35934597 DOI: 10.1016/j.revmed.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/04/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Before attending residency, 6th-year French medical students must validate a final examination including a practical clinical test in their faculty. However, the national ranking that determines their future specialty and region solely relies on a computerized knowledge test. Our goal was to investigate the association between the final faculty test and the national ranking test. METHODS In our faculty, the final examination includes a computerized theoretical test (similar to the national one) and a practical test: a standardized evaluation of semiology skills at the bedside and a standardized assessment of relational skills with role plays. The agreements between the national test and faculty computerized and practical tests were analyzed by intraclass correlation coefficients (ICC). RESULTS Data from 1806 students who underwent the three examinations from 2017 to 2021 were analyzed. There was a good agreement between the ranks in the faculty and national computerized tests: ICC 0.83 (95% CI 0.81-0.85). By contrast, the agreement between the ranks in the faculty practical test and the national computerized test was poor: ICC 0.13 (95% CI 0.08-0.17). Results were stable over the years. CONCLUSION The agreement between the ranking of the current national test and the clinical skills assessed by a specific faculty test is poor. This could relate to a true independence or to different levels of motivation to perform well. Indeed, the result of the national test is the most important one as it determines their career. Incorporating a clinical assessment into the national ranking test will motivate students to acquire clinical skills and value those who perform well this practical dimension.
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Affiliation(s)
- L Azoyan
- AP-HP, Hôpital Tenon, service de médecine interne, 4 rue de la Chine, 75020 Paris, France; Sorbonne Université, faculté de médecine, Paris, France.
| | - Y Lombardi
- AP-HP, Hôpital Tenon, soins intensifs néphrologiques et rein aigu, 4 rue de la Chine, 75020 Paris, France; Sorbonne Université, faculté de médecine, Paris, France
| | - M C Renaud
- Sorbonne Université, faculté de médecine, Paris, France
| | - A Duguet
- Sorbonne Université, faculté de médecine, Paris, France
| | - S Georgin-Lavialle
- AP-HP, Hôpital Tenon, service de médecine interne, 4 rue de la Chine, 75020 Paris, France; Sorbonne Université, faculté de médecine, Paris, France
| | - F Cohen-Aubart
- Sorbonne Université, faculté de médecine, Paris, France; AP-HP, Hôpital de la Pitié-Salpêtrière service de médecine interne 2, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - G Ibanez
- Sorbonne Université, faculté de médecine, Paris, France; Sorbonne Université, département de médecine générale, Paris, France
| | - O Steichen
- AP-HP, Hôpital Tenon, service de médecine interne, 4 rue de la Chine, 75020 Paris, France; Sorbonne Université, faculté de médecine, Paris, France; INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, équipe Sentinelles, 27 rue de Chaligny, 75012 Paris, France
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Azoyan L, Lombardi Y, Rech J, Haymann J, Wu C, Le Jeune S, Affo L, Chantalat Auger C, Bartolucci P, Leblanc J, Steichen O. Risque d’insuffisance rénale aiguë après injection de produit de contraste iodé chez les adultes atteints de drépanocytose : une série de cas autocontrôlés issue d’un entrepôt de données de santé multicentrique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Alhenc-Gelas M, Lefevre G, Bachmeyer C, M'Bappe P, Ouahabi S, Grateau G, Letavernier E, Steichen O. Poor performance of albumin or protein-adjusted plasma calcium to diagnose dyscalcemia in hospitalized patients: A confirmatory study in a general internal medicine department. Rev Med Interne 2021; 43:206-211. [PMID: 34953621 DOI: 10.1016/j.revmed.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/13/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hypo- and hypercalcemia are common and some causes require urgent diagnosis and treatment. Measurement of ionized calcium is the reference test to diagnose calcium disorders but total calcium adjusted for protein or albumin concentration is more often used. METHODS Patients hospitalised in a general internal medicine department from September 2013 to December 2015 who had a total plasma calcium concentration and a serum albumin or protein concentration measured within 24h of a ionized calcium blood measurement were included. Total calcium was adjusted for protein or albumin concentration using widely used formulas and compared to ionized calcium as the gold standard. RESULTS Among 210 included patients, 46 (22%) had hypocalcemia, 124 (59%) normocalcemia and 40 (19%) hypercalcemia according to ionized calcium concentration. Total calcium had 50% sensitivity and 95% specificity to diagnose hypocalcemia and a 93% sensitivity and 89% specificity to diagnose hypercalcemia. Adjusting total calcium for protein or albumin concentrations did not increase and sometimes decreased diagnostic accuracy. CONCLUSION Total calcium, with or without albumin/protein adjustment, is poorly sensitive to screen for hypocalcemia. Unadjusted total calcium is as sensitive as protein- or albumin-adjusted total calcium to screen for hypercalcemia. These data argue against the use of albumin- or protein-adjusted calcium. Ionized calcium measurement should be performed to confirm dyscalcemia in patients with abnormal total calcium concentration and to rule out hypocalcemia in patients with total calcium concentration in the lower range of normal values.
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Affiliation(s)
- M Alhenc-Gelas
- Service de médecine interne, Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, 75020 Paris, France
| | - G Lefevre
- Laboratoire de biochimie, Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, 75020 Paris, France
| | - C Bachmeyer
- Service de médecine interne, Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, 75020 Paris, France
| | - P M'Bappe
- Service de médecine interne, Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, 75020 Paris, France
| | - S Ouahabi
- Laboratoire de biochimie, Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, 75020 Paris, France
| | - G Grateau
- Service de médecine interne, Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, 75020 Paris, France
| | - E Letavernier
- Explorations fonctionnelles rénales, Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, 75020 Paris, France
| | - O Steichen
- Service de médecine interne, Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, 75020 Paris, France; Sorbonne université, Inserm, Institut Pierre-Louise d'épidémiologie et de santé publique (IPLESP, UMR-S1136), 75006 Paris, France.
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Lombardi Y, Azoyan L, Szychowiak P, Bellamine A, Lemaitre G, Bernaux M, Daniel C, Leblanc J, Riller Q, Steichen O. Validation externe des scores pronostiques de la Covid-19 en hospitalisation : une étude de cohorte multicentrique. Rev Med Interne 2021. [PMCID: PMC8610704 DOI: 10.1016/j.revmed.2021.10.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Patients et méthodes Résultats Conclusion
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Degroote T, Capron J, Santin A, Mattioni S, Rech J, Lionnet F, Steichen O. Dépistages des troubles cognitifs chez les adultes drépanocytaires avec le test du Montreal Cognitive Assessment (MoCA). Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wallet T, Lionnet F, Guedeney P, Haymann J, Bouziri N, Sy V, Steichen O, Isnard R, Montalescot G, Hammoudi N. Prevalence and factors associated with dyspnea in adult patients with Hemoglobin SC disease: a study of 221 cases. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cohen Aubart F, Papo T, Hertig A, Renaud MC, Steichen O, Amoura Z, Braun M, Palombi O, Duguet A, Roux D. Are script concordance tests suitable for the assessment of undergraduate students? A multicenter comparative study. Rev Med Interne 2020; 42:243-250. [PMID: 33288231 DOI: 10.1016/j.revmed.2020.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 10/04/2020] [Accepted: 11/08/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Script concordance tests (SCTs) have been developed to assess clinical reasoning in uncertain situations. Their reliability for the evaluation of undergraduate medical students has not been evaluated. METHODS Twenty internal medicine SCT cases were implemented in undergraduate students of two programs. The results obtained on the SCTs were compared to those obtained by the same students on clinical-based classical multiple-choice questions (MCQs). RESULTS A total of 551/883 students (62%) answered the SCTs. The mean aggregate score (based on a total 20 points) was 11.54 (3.29). The success rate and mean score for each question did not differ depending on the modal response but the discrimination rate did. The results obtained by the students on the SCT test correlated with their scores on the MCQ tests. Among students, 446/517 (86%) considered the SCTs to be more difficult than classical MCQs, although the mean score did not differ between the SCT and MCQ tests. CONCLUSION The use of SCTs is a feasible option for the evaluation of undergraduate students. The SCT scores correlated with those obtained on classical MCQ tests.
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Affiliation(s)
- F Cohen Aubart
- Service de médecine interne 2, Centre national de référence maladies systémiques rares et histiocytoses, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France.
| | - T Papo
- Département de médecine interne, hôpital Bichat, université de Paris, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - A Hertig
- Service de néphrologie et transplantation rénale, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - M-C Renaud
- Faculté de médecine, Sorbonne université, 75013 Paris, France
| | - O Steichen
- Service de médecine interne, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - Z Amoura
- Service de médecine interne 2, Centre national de référence maladies systémiques rares et histiocytoses, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - M Braun
- Service de neuroradiologie, université de Lorraine, CHRU de Nancy, 54035 Nancy, France
| | - O Palombi
- Service de neurochirurgie, université Grenoble Alpes, CHU de Grenoble, 38000 Grenoble, France
| | - A Duguet
- Service de Pneumologie, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - D Roux
- Service de médecine intensive réanimation, hôpital Louis-Mourier, université de Paris, Assistance publique-Hôpitaux de Paris, 92700 Colombes, France; Inserm, IAME, UMR-1137, 75018 Paris, France
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Delforge J, Sovaila S, Alix L, Didon A, Steichen O, Ranque B, Froissart A, Amadou K, Hanslik T, Cador B, Bergmann JF, Mekininan A, Goujard C, Gayet S, Cathebras P, Fantin B, Raigniac D, Weber JC, Rosenthal E, Hery L, Andres E, Benhamou Y, Bourgarit A. [Characteristics of patients admitted from emergency units in 18 internal medicine departments and organisation of these departments: A cross sectional study from SNFMI (SiFMI study group) in 2015]. Rev Med Interne 2020; 42:79-85. [PMID: 33160706 DOI: 10.1016/j.revmed.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/04/2020] [Accepted: 09/13/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients admitted from emergency units represent a large portion of the population in internal medicine departments. The aim of this study is to identify characteristics of patients and organization of these departments. METHODS Between June 29th and July 26th 2015, voluntary internal medicine departments from the SiFMI group prospectively filled anonymized internet forms to collect data of each patients admitted in their ward from emergency units, during seven consecutive days. RESULTS Three hundred and sixty-five patients from emergency departments were admitted in 18 internal medicine inpatients departments, totalling 1100 beds and 33,530 annual stays, 56% of them for emergency units inpatients. Mean age was 68 years, 54% were women, mean Charlson score was 2.6 and 44% of the patients took at least three drugs. Main causes of hospitalization were infectious (29%) and neurological (17%) diseases. Mean length of stay was 9.2 days. The medical team was composed by a median value of 4,5 [2,75-6,25] senior full-time equivalents, 86% were internists. Each department except one received residents, two third of them were from general medicine. CONCLUSION This study highlights a high organizational variability among internal medicine departments and patients, and sets internal medicine as a specialty with a great capacity to achieve an integrative/comprehensive management of patients and to offer a comprehensive basis for physicians in training.
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Affiliation(s)
- J Delforge
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - S Sovaila
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - L Alix
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - A Didon
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - O Steichen
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - B Ranque
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Froissart
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - K Amadou
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - T Hanslik
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - B Cador
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - J F Bergmann
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Mekininan
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - C Goujard
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - S Gayet
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - P Cathebras
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - B Fantin
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - D Raigniac
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - J C Weber
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - E Rosenthal
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - L Hery
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - E Andres
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Y Benhamou
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Bourgarit
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
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- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
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Postel-Vinay N, Blanc FX, Steichen O, Housset B, Clerson P, Eveillard P, Leroyer C, Roche N. [Pneumo-Quest: A standardised self-questionnaire to be completed at home before a first appointment at a respiratory clinic]. Rev Mal Respir 2020; 37:776-782. [PMID: 33071064 DOI: 10.1016/j.rmr.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
The Pneumo-Quest self-questionnaire was developed to standardize the practice of recollection when welcoming a new patient. It consists of 82 main questions and 34 subsidiary questions to be completed at home by the patients before their first visit to a pulmonologist. This evaluation was carried out on the basis of 137 returned questionnaires. The feasibility (main criterion) was good with 93±5% of the questions answered and an average completion time of 15.1±9.8minutes (mean±SD). The reliability of the responses (secondary criterion) was good with the agreement between the patient's response and the doctor's opinion being excellent or good for the majority of medical histories and treatments, as evidenced by the high values of the kappa coefficient (>0.90; <0.90; <0.75). Patient and physician perception of the questionnaire was good with 99% and 90% positive ratings, respectively. The use of the questionnaire was unhelpful in the course of the consultation in only 2% of cases. Doctors found the tool useful for obtaining a comprehensive history in 87% of cases and patients declared that it helped them "forgot nothing" in 93% of the cases. The questionnaire helped the doctor to identify the patient's problems rapidly in 71% of cases and saved time in 64%. These positive results encourage a wide dissemination of the questionnaire (www.pneumo-quest.com).
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Affiliation(s)
- N Postel-Vinay
- Service d'informatique médicale, hôpital européen Georges Pompidou, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France.
| | - F-X Blanc
- L'institut du thorax, service de pneumologie, CHU de Nantes, hôpital G. et R. Laënnec, boulevard J. Monod, 44093 Nantes cedex 1, France
| | - O Steichen
- Service de médecine interne, Hôpital Tenon, AP-HP, 75020 Paris, France
| | - B Housset
- Service de pneumologie, Hôpital intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - P Clerson
- Soladis Clinical Studies, Roubaix, France
| | | | - C Leroyer
- Département de médecine interne, vasculaire et pneumologie, hôpital La Cavale-Blanche, université européenne de Bretagne, Brest, France
| | - N Roche
- Service de pneumologie, hôpital Cochin, AP-HP, université de Paris, institut Cochin (UMR 1016), 75014 Paris, France
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Guégan S, Steichen O, Soria A. Literature review of perceptual learning modules in medical education: What can we conclude regarding dermatology? Ann Dermatol Venereol 2020; 148:16-22. [PMID: 32654795 DOI: 10.1016/j.annder.2020.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 12/08/2019] [Accepted: 01/16/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Visual pattern recognition is important in many different medical fields, particularly in dermatology. Perceptual learning modules (PLM) are software programs developed to enhance visual pattern recognition through the sequential presentation of images that trainee must quickly diagnose. The aim of this literature review was to determine the scope and effectiveness of PLM in medical education. METHODS We carried out a search of MEDLINE, EMBASE, Web of Science and ERIC from its inception through to July 1, 2017. All articles describing an educational intervention based on perceptual learning in a medical field were included. Two investigators worked independently on study selection and data extraction. RESULTS Of 191 references selected, 5 studies were included in the final analysis: 3 before-after studies and 2 randomized studies comparing 12 to 236 trainees taking PLM with 12 to 316 trainees not taking PLM. Four studies reported a statistically significant increase in diagnostic accuracy (lower error rate) and fluency (shorter response time) following PLM interventions (dermatology, pathology, echocardiography), with long-term persistence of the effect in three studies. CONCLUSION PLM is a promising educational tool to teach pattern recognition that may be used in dermatology and other medical fields to improve diagnostic accuracy and rapidity in daily practice.
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Affiliation(s)
- S Guégan
- Université Paris Descartes, Paris, France; Service de dermatologie, hôpital Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France.
| | - O Steichen
- Faculté de médecine, Sorbonne universités, Paris, France; Service de médecine interne, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, Paris, France
| | - A Soria
- Faculté de médecine, Sorbonne universités, Paris, France; Service de dermato-allergologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
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Penet M, Saint-Val L, Gerin M, Steichen O, Froissart A, Bourgarit A, Ranque B. Facteurs de risque de réaction paradoxale au cours du traitement de la tuberculose extrapulmonaire du sujet immunocompétent. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bourguiba R, Santin A, Mattioni S, Stankovic K, Lionnet F, Steichen O. Variation intra-individuelle de l’hémoglobine chez les patients drépanocytaires à l’état stable. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Galland J, Zilberman S, Thomassin-Nagara I, Varinot J, Steichen O. Manifestations générales et extra-mammaires des mastites granulomateuses idiopathiques. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Roger C, Lionnet F, Kyheng M, Mattioni S, Livrozet M, Steichen O, Letavernier E, Hammoudi N, Duhamel A, Haymann J. Facteurs prédictifs de dégradation de la fonction rénale dans une population de patients drépanocytaires homozygotes adultes. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Vilcu A, Sabatte L, Blanchon T, Souty C, Maravic M, Steichen O, Hanslik T. Risk of viral gastroenteritis associated with continuous use of proton pump inhibitors: a matched retrospective cohort study based on prospectively collected drug dispensing data. Ann Epidemiol 2019. [DOI: 10.1016/j.annepidem.2019.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Capron J, Grateau G, Steichen O. The missing link between familial Mediterranean fever and recurrent aseptic meningitis. Pediatr Neonatol 2019; 60:350. [PMID: 30954407 DOI: 10.1016/j.pedneo.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/07/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- J Capron
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint Antoine, Service de neurologie, F-75012, Paris, France.
| | - G Grateau
- Assistance Publique - Hôpitaux de Paris, Hôpital Tenon, Service de médecine interne, F-75020, Paris, France
| | - O Steichen
- Assistance Publique - Hôpitaux de Paris, Hôpital Tenon, Service de médecine interne, F-75020, Paris, France
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Conan P, Steichen O, Santin A, Bachmeyer C, Bappé P, Lionnet F, Mattioni S. Ostéomyélites chez les adultes drépanocytaires : étude descriptive en pays à haut revenu. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bonnard G, Cohen-Aubart F, Steichen O, Bourgarit A, Abad S, Ranque B, Pouchot J, Dossier A, Espitia-Thibault A, Jego P, Granel B, Launay D, Rivière E, Le Jeunne C, Mouthon L, Pottier P. [Reliability and validity of a workbook for assessment of professional competencies of internal medicine residents]. Rev Med Interne 2019; 40:419-426. [PMID: 30871866 DOI: 10.1016/j.revmed.2019.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/25/2019] [Accepted: 02/10/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Though several assessment tools for resident professional skills based on workplace direct observation have been validated, they remain scarcely used in France. The objective of this study was to evaluate the reliability and the validity of a workbook including several assessment forms for different components of the professional competency. METHODS Three assessment forms have been tested over a period of 6 months in a multicentric study including 12 French internal medicine departments: the French version of the mini-CEX, an interpersonal skills assessment form (OD_CR) and the multisource feedback form (E_360). Reliability has been assess using the intra-class correlation coefficient (ICC) and the Cronbach alpha coefficient. Arguments for validity have been provided looking at the ability of the forms to detect an increase in the scores over time and according to the level of experience of the resident. RESULTS Twenty-five residents have been included. The Cronbach alpha was of 0.90 (n=70) with the mini-CEX, 0.89 with the OD_CR (n=62) and 0.77 with the E_360 (n=86). ICC showed a wide variation according to the items of the mini-CEX and the OD-CR probably due to the poor number of observations performed by residents. The scores of most of the items of these two forms increased between M1 and M6. The scores of the E_360 were high: 7.3±0.8 to 8.3±2.4 (maximum 9) and did not vary according to the level of experience. CONCLUSION This study suggest that it would be difficult to ensure a sufficient reliability for professional skills assessment using these tools given our available current human and material resources. However, these assessment forms could be added to the resident portfolio as supports for the debriefing in order to document their progression during their formation.
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Affiliation(s)
- G Bonnard
- Service de médecine interne, Hôtel-Dieu, CHU de Nantes, 44093 Nantes, France
| | - F Cohen-Aubart
- Service de médecine interne 2, Sorbonne Université, hôpital de la Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris (AP-HP), 75013 Paris, France
| | - O Steichen
- Service de Médecine Interne, université Paris-VI Pierre-et-Marie-Curie, hôpital Tenon, AP-HP, 75970 Paris, France
| | - A Bourgarit
- Service de médecine interne, hôpital Jean Verdier, AP-HP, 93140 Bondy, France
| | - S Abad
- Service de médecine interne, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - B Ranque
- Service de médecine interne, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - J Pouchot
- Service de médecine interne, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - A Dossier
- Service de médecine interne, hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, AP-HP, 75877 Paris, France
| | - A Espitia-Thibault
- Service de médecine interne, Hôtel-Dieu, CHU de Nantes, 44093 Nantes, France
| | - P Jego
- Service de médecine interne, CHU de Rennes, 35200 Rennes, France
| | - B Granel
- Service de médecine interne, CHU Nord, Assistance publique-Hôpitaux de Marseille, 13015 Marseille, France
| | - D Launay
- Département de médecine interne et immunologie clinique, CHU Lille, 59037 Lille, France
| | - E Rivière
- Service de médecine interne et maladies infectieuses, hôpital Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - C Le Jeunne
- Service de médecine interne, hôpital Cochin, université Paris Descartes, AP-HP, 75014 Paris, France
| | - L Mouthon
- Service de médecine interne, hôpital Cochin, université Paris Descartes, AP-HP, 75014 Paris, France
| | - P Pottier
- Service de médecine interne, Hôtel-Dieu, CHU de Nantes, 44093 Nantes, France; SPHERE U1246, Inserm, université de Nantes-université de Tours, 44000 Nantes, France.
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Conan P, Steichen O, Santin A, Bachmeyer C, M’bappe P, Lionnet F, Mattioni S. Ostéomyélites chez les adultes drépanocytaires : étude descriptive en pays à haut revenu. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lampros A, Montardi C, Georgin-Lavialle S, Dhôte R, Goujard C, Hanslik T, Le Jeunne C, Mahe I, Papo T, Bourgarit A, Nevoret C, Steichen O. Effet des comorbidités psychiatriques sur la durée de séjour des patients en Médecine Interne d’aval des Urgences. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rosso C, Steichen O, Leger A. Y a-t-il un plafond de verre pour les femmes dans les carrières hospitalo-universitaires en France ? Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Alhenc-Gelas M, Ouahabi S, Bachmeyer C, Bappe P, Grateau G, Lefevre G, Letavernier E, Steichen O. Calcémie totale et calcémie corrigée par l’albumine ou les protéines totales : valeur diagnostique chez les patients hospitalisés en médecine interne. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bellamine A, Hertig A, Roux D, Steichen O, Leccas A, Renaud M, Noel N, Amoura Z, Duguet A, Cohen Aubart F. Analyse docimologique et réussite aux questions à réponses multiples des étudiants de DFASM3 : données de 2 épreuves d’entraînement franciliennes et analyse des ECNi 2016–2017. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pottier P, Cohen Aubart F, Steichen O, Desprets M, Pha M, Espitia A, Georgin-Lavialle S, Morel A, Hardouin JB. [Validity and reproducibility of two direct observation assessment forms for evaluation of internal medicine residents' clinical skills]. Rev Med Interne 2017; 39:4-9. [PMID: 29157753 DOI: 10.1016/j.revmed.2017.10.424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 09/05/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The revision of the French medical studies' third cycle ought to be competency-based. In internal medicine, theoretical and practical knowledge will be assessed online with e-learning and e-portfolio. In parallel, a reflection about clinical skills assessment forms is currently ongoing. In this context, our aim was to assess the reproducibility and validity of two assessment forms based on direct clinical observation. METHOD A prospective and multicentric study has been conducted from November 2015 to October 2016 aiming at evaluating the French translations of the MINI-Clinical Examination Exercice (MINI-CEX) and the Standardized Patient Satisfaction Questionnaire (SPSQ). Included residents have been assessed 2 times over a period of 6 months by the same binoma of judges. RESULTS Nineteen residents have been included. The inter-judge reproducibility was satisfactory for the MINI-CEX: intraclass coefficients (ICC) between 0.4 and 0.8 and moderate for the SPSQ: ICC between 0.2 and 0.7 with a good internal coherence for both questionnaires (Cronbach between 0.92 and 0.94). Significant differences between the distributions of the scores given by the judges and a significant inter-center variability have been found. CONCLUSION If the absolute value of the scores should not be taken into account in the evaluation process given its high variability, it could be of interest for the follow-up of the progression in the competencies. These forms could support the residents' debriefing based on the general trends given by the scores.
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Affiliation(s)
- P Pottier
- Service de médecine interne, Hôtel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes, France; SPHERE U1246, Inserm, université de Nantes-université de Tours, 44000 Nantes, France.
| | - F Cohen Aubart
- Service de médecine interne 2, hôpital de la Pitié-Salpêtrière, université Paris-VI - Pierre-et-Marie-Curie, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - O Steichen
- Service de médecine interne, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 75970 Paris, France
| | - M Desprets
- Service de médecine interne, Hôtel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes, France
| | - M Pha
- Service de médecine interne 2, hôpital de la Pitié-Salpêtrière, université Paris-VI - Pierre-et-Marie-Curie, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - A Espitia
- Service de médecine interne, Hôtel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes, France
| | - S Georgin-Lavialle
- Service de médecine interne, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 75970 Paris, France
| | - A Morel
- SPHERE U1246, Inserm, université de Nantes-université de Tours, 44000 Nantes, France
| | - J B Hardouin
- SPHERE U1246, Inserm, université de Nantes-université de Tours, 44000 Nantes, France
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Abstract
OBJECTIVE To select papers published in 2014, illustrating how information technology can contribute to and improve patient-centered care coordination. METHOD The two section editors performed a literature review from Medline and Web of Science to select a list of candidate best papers on the use of information technology for patient-centered care coordination. These papers were peer-reviewed by external reviewers and three of them were selected as "best papers". RESULTS The first selected paper reports a qualitative study exploring the gap between current practices of care coordination in various settings and idealized longitudinal care plans. The second selected paper illustrates several unintended consequences of HIT designed to improve care coordination. The third selected paper shows that advanced analytic techniques in medical informatics can be instrumental in studying patient-centered care coordination. CONCLUSIONS The realization of true patient-centered care coordination is dependent upon a number of factors. Standardization of clinical documentation and HIT interoperability across organization and settings is a critical prerequisite for HIT to support patient-centered care coordination. Enabling patient involvement is an efficient means for goal setting and health information sharing. Additionally, unintended consequences of HIT tools (both positive and negative) must be measured and taken into account for quality improvement.
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Affiliation(s)
- O Steichen
- Olivier Steichen, Service de médecine interne, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France, Tel: +33 (0) 1 56 01 78 31, Fax: +33 (0) 1 56 01 71 13, E-mail:
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Froissart A, Rossi B, Ranque B, Steichen O, Jarrin I, Bergmann J, Dautheville S, Gault N, Roy C, Zarrouk V, Fantin B. Une transfusion « ponctuelle » ne modifie pas l’interprétation des dosages biologiques utiles à la compréhension de l’étiologie d’une anémie. Résultats d’une étude prospective : l’étude BÉA/T. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fayand A, Dzierzynski N, Georgin-Lavialle S, Lionnet F, Steichen O. Influence des comorbidités psychiatriques sur le recours hospitalier pour crise vaso-occlusive chez l’adulte drépanocytaire : une étude de cohorte. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fraisse T, Bastard J, Fellahi S, Steichen O, Stankovic K, Avellino V, Hentgen V, Faintuch J, Amselem S, Grateau G, Georgin-Lavialle S. Cytolyse au cours de la fièvre méditerranéenne familiale : étude prospective chez 19 adultes. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Eychenne N, Jaouadi A, Macquart de Terline D, Fratta A, Laribe-Caget S, Steichen O, Fernandez C, Antignac M. [Assessment of physicians' and nurses' knowledge and practices of aerosol therapy]. Rev Mal Respir 2016; 34:553-560. [PMID: 27863827 DOI: 10.1016/j.rmr.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/17/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Aerosol therapy is an efficient, but complex procedure. National and international practice guidelines are regularly updated. However, only a few studies have assessed the application of guidelines by users. The aim of this study is to assess the knowledge and practices of physicians and nurses regarding these guidelines. METHODS Two self-administered questionnaires were designed by a working team and presented to physicians and nurses of four university hospitals in Paris. A pharmacy resident collected and analyzed the data with the aid of an online survey website. RESULTS A total of 481 physicians and nurses completed the questionnaires (33 % of physicians and 67 % of nurses). Only 241/480 physicians and nurses (50 %) knew that several intravenous drugs cannot be nebulized. Ninety-four of 422 (22 %) of them always choose oxygen as the driving gas and 239/311 nurses (77 %) think that single use nebulizers can be re-used for the same patient. CONCLUSIONS This survey shows that many physicians and nurses lack knowledge and use inappropriate practices. Based on these results, a booklet has been designed by the working team. This booklet should help health professionals to harmonize practices across hospitals and to follow the guidelines correctly.
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Affiliation(s)
- N Eychenne
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - A Jaouadi
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - D Macquart de Terline
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - A Fratta
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Armand-Trousseau, 75012 Paris, France
| | - S Laribe-Caget
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Rothschild, 75012 Paris, France
| | - O Steichen
- Service de médecine interne, hôpitaux universitaires Est-Parisien, AP-HP, site Tenon, 75020 Paris, France; Faculté de médecine, UPMC, université Paris 6, Sorbonne universités, 75005 Paris, France
| | - C Fernandez
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Département de pharmacie clinique, faculté de pharmacie, université Paris Sud, 92290 Châtenay-Malabry, France
| | - M Antignac
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Scheifer C, Georgin-Lavialle S, Dzierzynski N, Mattioni S, Bachmeyer C, Garandeau E, Bouvard E, Grateau G, Steichen O. Intrication des problèmes psychiatriques et somatiques en médecine d’aval des urgences : étude transversale de 104 séjours. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Plouin PF, Amar L, Dekkers OM, Fassnacht M, Gimenez-Roqueplo AP, Lenders JWM, Lussey-Lepoutre C, Steichen O. European Society of Endocrinology Clinical Practice Guideline for long-term follow-up of patients operated on for a phaeochromocytoma or a paraganglioma. Eur J Endocrinol 2016; 174:G1-G10. [PMID: 27048283 DOI: 10.1530/eje-16-0033] [Citation(s) in RCA: 276] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/19/2016] [Indexed: 11/08/2022]
Abstract
Phaeochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumours. Standard treatment is surgical resection. Following complete resection of the primary tumour, patients with PPGL are at risk of developing new tumoural events. The present guideline aims to propose standardised clinical care of long-term follow-up in patients operated on for a PPGL. The guideline has been developed by The European Society of Endocrinology and based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles. We performed a systematic review of the literature and analysed the European Network for the Study of Adrenal Tumours (ENS@T) database. The risk of new events persisted in the long term and was higher for patients with genetic or syndromic diseases. Follow-up in the published cohorts and in the ENS@T database was neither standardised nor exhaustive, resulting in a risk of follow-up bias and in low statistical power beyond 10 years after complete surgery. To inform patients and care providers in this context of low-quality evidence, the Guideline Working Group therefore prepared recommendations on the basis of expert consensus. Key recommendations are the following: we recommend that all patients with PPGL be considered for genetic testing; we recommend assaying plasma or urinary metanephrines every year to screen for local or metastatic recurrences or new tumours; and we suggest follow-up for at least 10 years in all patients operated on for a PPGL. High-risk patients (young patients and those with a genetic disease, a large tumour and/or a paraganglioma) should be offered lifelong annual follow-up.
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Affiliation(s)
- P F Plouin
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
| | - L Amar
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
| | - O M Dekkers
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
| | - M Fassnacht
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
| | - A P Gimenez-Roqueplo
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
| | - J W M Lenders
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
| | - C Lussey-Lepoutre
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France
| | - O Steichen
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
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Roze E, Flamand-Roze C, Méneret A, Ruiz M, Le Liepvre H, Duguet A, Renaud MC, Alamowitch S, Steichen O. ‘The Move’, an innovative simulation-based medical education program using roleplay to teach neurological semiology: Students’ and teachers’ perceptions. Rev Neurol (Paris) 2016; 172:289-94. [DOI: 10.1016/j.neurol.2016.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
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Abbara S, Georgin-Lavialle S, Grateau G, Bachmeyer C, Buob D, Senet P, Audia S, Delcey V, Steichen O, Bastard JP, Fellahi S, Amselem S, Stankovic Stojanovic K. Hidradenitis suppurativa and familial Mediterranean fever: a report of 6 cases and literature review. Pediatr Rheumatol Online J 2015. [PMCID: PMC4599933 DOI: 10.1186/1546-0096-13-s1-p105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Garandeau E, Georgin-Lavialle S, Steichen O, Stankovic K, Mattioni S, Bachmeyer C, Girot R, Grateau G, Lionnet F. Syndrome de la houppe mentonnière chez patients drépanocytaires : étude de 35 cas. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Felizardo Lopes I, Dezelée S, Brault D, Steichen O. Prevalence, risk factors and prognosis of hypernatraemia during hospitalisation in internal medicine. Neth J Med 2015; 73:448-454. [PMID: 26687260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Hypernatraemia in hospitalised patients is less common and less studied than hyponatraemia, although it also seems to be associated with a poor prognosis. The present study evaluates its prevalence, risk factors and prognosis in an internal medicine department. METHODS Full hospital stays over 28 months in a 36-bed internal medicine department were analysed retrospectively. Patients with at least one plasma sodium ≥ 150 mmol/l were compared first with all other patients and then individually with sex- and age-matched normonatraemic controls. RESULTS Plasma sodium ≥ 150 mmol÷l was observed during 49÷1945 hospitalisations (2.6%); it was acquired during hospitalisation in 30 cases (61%). Hypernatraemic patients were significantly older with no gender difference. They were comparable with their matched normonatraemic controls regarding the Charlson comorbidity index, although individual comorbidities varied. They were bedridden in 45% vs 15% for controls (p = 0.001). Nearly one-third of hypernatraemic patients had an increased extracellular fluid volume. Hypernatraemia was associated with higher in-hospital mortality (43% vs 2%, p < 0.001) and longer hospitalisation (median 21 vs 10 days, p = 0.004). CONCLUSION Hypernatraemia is more likely to occur in older and dependent patients and is associated with poor prognosis. Unlike classical teaching, it is often associated with increased extracellular fluid volume, even outside intensive care units.
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Georgin-Lavialle S, Grateau G, Mattioni S, Steichen O. Prescriptions pédagogiques pour favoriser l’apprentissage actif des connaissances par les étudiants hospitaliers en stage de médecine interne : à propos de 150 situations. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sosner P, Ott J, Steichen O, Bally S, Krummel T, Brucker M, Lequeux B, Dourmap C, Llaty P, Le Coz S, Baguet S, Miranne A, Labrunée M, Gremeaux V, Lopez-Sublet M. [Physical activity level and home blood pressure measurement: Pilot study "Acti-HTA"]. Ann Cardiol Angeiol (Paris) 2015; 64:205-209. [PMID: 26047874 DOI: 10.1016/j.ancard.2015.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 04/28/2015] [Indexed: 06/04/2023]
Abstract
While physical activity (PA) is recommended for high blood pressure management, the level of PA practice of hypertensive patients remains unclear. We aimed to assess the association between the level of both PA and blood pressure of individuals consulting in 9 hypertension specialist centres. Eighty-five hypertensive patients were included (59 ± 14 years, 61% men, 12% smokers, 29% with diabetes). Following their consultation, they performed home blood pressure measurement (HBPM) over 7 days (2 in the morning+2 in the evening), they wrote in a dedicated form their daily activities to estimate the additional caloric expenditure using Acti-MET device (built from International physical Activity Questionnaire [IPAQ]). Thus, patients completed a self-administered questionnaire "score of Dijon" (distinguishing active subjects with a score>20/30, from sedentary<10/30). Subjects with normal HBPM value (<135/85 mm Hg) (55% of them) compared to those with high HBPM were older, had a non-significant trend towards higher weekly caloric expenditure (4959 ± 5045 kcal/week vs. 4048 ± 4199 kcal/week, P=0.3755) and score of Dijon (19.44 ± 5.81 vs. 18.00 ± 4.32, P=0.2094) with a higher proportion of "active" subjects (48.9% vs. 34.2%, P=0.1773). In conclusion, our results demonstrate a "tendency" to a higher level of reported PA for subjects whose hypertension was controlled. This encourages us to continue with a study that would include more subjects, which would assess PA level using an objective method such as wearing an accelerometer sensor.
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Affiliation(s)
- P Sosner
- Centre médico-sportif Mon Stade, 5, rue Elsa-Morante, 75013 Paris, France; Laboratoire MOVE (EA6314), université de Poitiers, 8, allée Jean-Monnet, 86000 Poitiers, France; Centre de diagnostic, Hôtel-Dieu, AP-HP, 1, parvis Notre-Dame, 75004 Paris, France.
| | - J Ott
- Service de néphrologie, centre hospitalier d'Haguenau, 64, avenue Pr-Leriche, 67500 Haguenau, France
| | - O Steichen
- Service de médecine interne, hôpital Tenon, AP-HP, 4, rue Chine, 75020 Paris, France
| | - S Bally
- Service de néphrologie-dialyse, centre hospitalier Métropole Savoie, place Lucien-Biset, 73011 Chambéry, France
| | - T Krummel
- Service de néphrologie, CHU de Strasbourg, 1, place Hôpital, 67000 Strasbourg, France
| | - M Brucker
- Service de néphrologie, centre hospitalier de Valence, 179, avenue Maréchal-Juin, 26000 Valence, France
| | - B Lequeux
- Service de cardiologie, CHU de Poitiers, 2, rue Milétrie, 86021 Poitiers, France
| | - C Dourmap
- Service de cardiologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - P Llaty
- Service de cardiologie, CHU de Poitiers, 2, rue Milétrie, 86021 Poitiers, France
| | - S Le Coz
- Service de néphrologie, centre hospitalier de Saint-Nazaire, 11, boulevard Georges-Charpak, 44606 Saint-Nazaire, France
| | - S Baguet
- Service de cardiologie, groupe hospitalier Mutualiste, 8, rue Dr-Calmette, 38000 Grenoble, France
| | - A Miranne
- Faculté de médecine et de pharmacie, université de Poitiers, 6, rue Milétrie, 86000 Poitiers, France
| | - M Labrunée
- Médecine physique et réadaptation, hôpital Rangueil, CHU de Toulouse, 1, avenue Pr-Jean-Poulhès, 31059 Toulouse, France
| | - V Gremeaux
- Pôle rééducation-réadaptation, CHU de Dijon, 23, rue Gaffarel, 21000 Dijon, France; Inserm U1093 « cognition, action, et plasticité sensorimotrice », 21078 Dijon, France
| | - M Lopez-Sublet
- Service de médecine interne, CHU Avicenne, AP-HP, 125, rue Stalingrad, 93000 Bobigny, France
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Steichen O. Methodological flaws in the systematic review and meta-analysis on glucose metabolism disorders in patients with primary aldosteronism. Ir J Med Sci 2015; 185:271-2. [PMID: 25682111 DOI: 10.1007/s11845-015-1269-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 02/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- O Steichen
- Internal Medicine Department, AP-HP, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France. .,Faculty of Medicine, Université Pierre et Marie Curie-Paris 6, 75006, Paris, France. .,LIMICS, UMR_S1142, INSERM, 75006, Paris, France.
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Steichen O, Georgin-Lavialle S, Grateau G, Ranque B. [Assessment of clinical observation skills of last year medical students]. Rev Med Interne 2014; 36:312-8. [PMID: 25458867 DOI: 10.1016/j.revmed.2014.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 07/06/2014] [Accepted: 10/08/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE Clinical examination skills are poorly evaluated by theoretical tests. We observed the clinical examination of real patients by 6th year medical students. METHODS Four internists involved in teaching activities defined 11 clinical examination items, with two objective performance criteria each. The students were evaluated in two internal medicine departments during the rotation preceding or following their national graduation test. Scores by item and by criterion and an overall score were calculated and correlated with their rank at the national graduation test. RESULTS Thirty-two students were evaluated in one department and 18 in the other; each evaluation lasted approximately 30 minutes. The results were similar in both departments. Only 2 items got a score over 75% in this students' sample (acute respiratory failure, peripheral pulses); 4 items were satisfied at less than 50% (lymph nodes, right heart failure, liver failure, and attention). The mean overall score was 6.5/11 (standard deviation 1.5). National rankings were good (median 1605/8001, interquartile 453-3036) but uncorrelated with the global score (Spearman coefficient -0.13; P=0.39). CONCLUSION Bedside evaluation of the students reveals substantial deficiencies, a few months or weeks before taking their position as residents. Several elementary skills are mastered by a minority of them (search for an asterixis, distended jugular veins, deep tendon reflexes), even among those successful at the national graduation test. Bedside evaluation of clinical examination skills should be more systematically performed.
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Affiliation(s)
- O Steichen
- Service de médecine interne, hôpital Tenon, 4, rue de la Chine, AP-HP, 75020 Paris, France; Faculté de médecine, Sorbonne universités, UPMC université Paris 06, 75006 Paris, France; Inserm, U1142, LIMICS, 75006 Paris, France.
| | - S Georgin-Lavialle
- Service de médecine interne, hôpital Tenon, 4, rue de la Chine, AP-HP, 75020 Paris, France; Faculté de médecine, Sorbonne universités, UPMC université Paris 06, 75006 Paris, France
| | - G Grateau
- Service de médecine interne, hôpital Tenon, 4, rue de la Chine, AP-HP, 75020 Paris, France; Faculté de médecine, Sorbonne universités, UPMC université Paris 06, 75006 Paris, France
| | - B Ranque
- Département de médecine interne, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France
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Steichen O. Revues systématiques et méta-analyses. Rev Med Interne 2014; 35:558. [DOI: 10.1016/j.revmed.2014.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
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Felizardo Lopes I, Dezelée S, Garcia Rodrigues N, Brault D, Steichen O. Prévalence, facteurs de risque et signification pronostique de l’hypernatrémie lors d’une hospitalisation en médecine interne. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Steichen O, Plouin PF. Prise en charge actuelle de l’hypertension artérielle. Rev Med Interne 2014; 35:235-42. [DOI: 10.1016/j.revmed.2013.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
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Affiliation(s)
- O Steichen
- AP-HP, Tenon Hospital, Internal Medicine Department, F-75020, Paris, France; Université Pierre et Marie Curie-Paris 6, Faculty of Medicine, F-75006, Paris, France; INSERM, U1142, LIMICS, F-75006, Paris, France.
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Gallais Sérézal I, Le Jeune S, Belenfant X, Bakir R, Fain O, Mekinian A, Gambier N, Mouthon L, Steichen O, Blanche P, Mourad JJ, Dhôte R. [Idiopathic retroperitoneal fibrosis: a multicentric retrospective study of 30 French cases and follow-up of the renal function]. Rev Med Interne 2013; 35:570-6. [PMID: 24314845 DOI: 10.1016/j.revmed.2013.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 09/23/2013] [Accepted: 11/02/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE Idiopathic retroperitoneal fibrosis (IRF) is an inflammatory disorder, affecting the aorta and the surrounding vessels and tissues. The prognosis is mainly driven by the risks of chronic kidney disease and relapse. Our aim was to assess the prevalence of chronic kidney disease at follow-up. METHODS We retrospectively reviewed the medical records of patients diagnosed for IRF in Seine-Saint-Denis (France) between 1987 and 2011. We collected informations about presentation, radiologic findings and follow-up. Diagnosis of IRF was confirmed when all the following criteria were met: infiltration of the infrarenal aorta or iliac vessels, absence of aneurysmal dilation, lack of clinical suspicion of malignancy. RESULTS Thirty patients were identified, with a male/female ratio of 4.9. Mean age was 55±13 years old. The mean creatinine clearance was 66 mL/min/1.73 m(2) and the mean CRP was 45±36 mg/L. In 24 (80%) patients, the location of IRF was periaortic and periiliac. Eleven patients (37%) underwent a diagnostic biopsy, and 14 (47%) required an ureteral procedure. A mean follow-up of 63 months was available for 29 patients: 69% relapsed, 7 developed chronic renal disease (24%), and one died of urinary sepsis. Older age (P=0.023), diabetes (P=0.007), and initial renal insufficiency (P=0.05) were associated with a risk of chronic renal insufficiency. CONCLUSION The high frequency of relapses and chronic renal disease emphasizes the need of close follow-up in patients diagnosed with IRF.
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Affiliation(s)
- I Gallais Sérézal
- Service de médecine interne, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), UPRES EA3509, laboratoire de recherche clinique et thérapeutique, université Paris-13, Sorbonne Paris-Cité, 93000 Bobigny, France.
| | - S Le Jeune
- Service de médecine interne, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), UPRES EA3509, laboratoire de recherche clinique et thérapeutique, université Paris-13, Sorbonne Paris-Cité, 93000 Bobigny, France
| | - X Belenfant
- Service de néphrologie, hôpital André-Grégoire, 93100 Montreuil, France
| | - R Bakir
- Service de médecine interne, hôpital Robert-Ballanger, 93600 Aulnay-sous-Bois, France
| | - O Fain
- Service de médecine interne, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-13, Sorbonne Paris-Cité, 93140 Bondy, France
| | - A Mekinian
- Service de médecine interne, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-13, Sorbonne Paris-Cité, 93140 Bondy, France
| | - N Gambier
- Hôpital Delafontaine, 93200 Saint-Denis, France
| | - L Mouthon
- Service de médecine interne, hôpital Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), 75005 Paris, France
| | - O Steichen
- Service de médecine interne, hôpital Tenon, Assistance publique-Hôpitaux de Paris (AP-HP), 75020 Paris, France
| | - P Blanche
- Service de médecine interne, hôpital Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), 75005 Paris, France
| | - J-J Mourad
- Service de médecine interne, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), UPRES EA3509, laboratoire de recherche clinique et thérapeutique, université Paris-13, Sorbonne Paris-Cité, 93000 Bobigny, France
| | - R Dhôte
- Service de médecine interne, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), UPRES EA3509, laboratoire de recherche clinique et thérapeutique, université Paris-13, Sorbonne Paris-Cité, 93000 Bobigny, France
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Sovaila S, Purcarea A, Froissart A, Ranque B, Steichen O, Kieffer P, Andres E, Goujard C, Hanslik T, Weber J, Bergmann J, Bourgarit-Durand A, Andres E, Arlet JB, Aslangul E, Bergman JF, Bourgarit A, Fantin B, Fardet L, Federici L, Froissart A, Goujard G, Grunenberger F, Hanslik T, Kettaneh A. Valeur formatrice en premier semestre d’internat d’un stage en médecine interne : évaluation quantitative et comparative par Tests de Concordance de Script : étude multicentrique pilote. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ranque B, Georgin-Lavialle S, Grateau G, Steichen O. Évaluation des compétences en sémiologie des étudiants en fin de deuxième cycle des études médicales. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stankovic Stojanovic K, Steichen O, Hentgen V, Fellahi S, Georgin-Lavialle S, Jéru I, Amselem S, Bastard JP, Grateau G. Concordance entre la CRP et la SAA dans la fièvre méditerranéenne familiale hors crise : étude sur 218 patients. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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