B Acad Nat Med Paris
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B Acad Nat Med Paris · Jun 2020
Review[Continuing professional development and recertification process in France].
Continuing medical education (CME) is an obligation in France. The evaluation of professional practices joined in 2004 the obligation to acquire knowledge, becoming the Continuing professional development (CPD) in 2009. Currently, the system is complete: definition, organization and validation. ⋯ The recertification mission who prepared the law excludes all knowledge verification tests. Recertification is done by promoting the professional career path including, in addition to CPD, a maintained and regular activity, an improvement in the relationship with the patient, taking into account the doctor's health and the absence of undesirable events. Seeing that the French Medical Council oversees the professional skills of physicians, it is the Council that receives the validation of the CPD and will receive that of recertification.
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Despite the frequency of psychiatric comorbidities, substance use disorder must be understood as an autonomous pathology due to its own determinants, semiology and possibilities of evolution, either spontaneous or under treatment. The ease of access to multiple synthetic products via the Internet combined with the creativity of chemists are contributing to the emergence of novel practices ranging from chemsex to purple drank. ⋯ The physician needs to hear the patient powerlessness hidden behind the craving and propose a therapy that may be chemical (including substitution treatment) and psychological. Most of the time, social support is necessary to correct the desocializing effects of substance use disorder or addictive behaviours.
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B Acad Nat Med Paris · Jun 2020
Review[Abnormal consequences of non-faulty medical accidents: Jurisprudence of the Conseil d'État].
Compensation for no-fault medical accidents to professionals or establishments is provided for by article L. 1142-1 of the public health code, created by the law of March 4, 2002 relating to the rights of patients and the quality of the health system. It indicates the conditions of accountability, clinical criteria and severity. Among the clinical criteria "a medical accident (…) gives the right to compensation for damages (…) in the name of national solidarity, when (…) they have had abnormal consequences for the patient in view of his condition as well as the foreseeable evolution of it (…)". ⋯ According to the jurisprudence of the Conseil d'État of December 12, 2014 the condition of abnormality is always "satisfied when the medical act entailed consequences significantly more serious than those to which the patient was exposed in a sufficiently probable way in the absence of treatment". And if this is not the case, "they cannot be regarded as abnormal unless, under the conditions in which the act was performed, the occurrence of damage presented a low probability; that thus, they cannot be regarded as abnormal with regard to the state of the patient when the gravity of this state led to practicing an act involving high risks whose realization is at the origin of the damage". The Conseil d'État specified in 2019 that a probability of occurrence of 3% was a low probability.
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B Acad Nat Med Paris · Mar 2016
Review[SPA therapy for pain of patients with chronic low back pain, knee osteo-arthritis and fibromyalgia].
The data of 33 randomized controlled trials suggest that chronic pain of patients with chronic low back pain, knee osteo-arthritis, fibromyalgia is significantly improved by balneotherapy and significantly better improved than by control treatments. For chronic low back pain (10 RCT, 1192 patients) pain was better improved in balneotherapy group and the weighted mean of the differential improvement was 19.66 (95 % CI: 16.6 ; 22.8) and the effect size was 1.1 (95 %CI: 0.82 ; 1.38) favouring balneotherapy. For knee osteo-arthritis pain (17 RCT, 1428 patients) pain was better improved in balneotherapy group and the weighted mean of the differential improvement was 13.24 (95 % CI: 5.52 ; 20.96) and the effect size was 0.72 (95 %CI: 0.51 ; 0.93) favouring balneotherapy. ⋯ Balneotherapy is a safe treatment as only 1 % of the patients receiving balneotherapy had to interrupt the treatment. However several methodological biases were observed in many trials, mainly a lack of statistical power due to a limited enrolment of patients, an insufficient duration of follow-up, an inhomogeneity of treatments. The clinical benefit has to be confirmed by stronger data of evidence but these data are sufficient to perform a more complete scientific analysis (meta-analysis) ; but further clinical investigations with a better methodological quality remain necessary.
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B Acad Nat Med Paris · Mar 2016
Review[Plasmodium falciparum resistance to artemisinin-based combination therapies (ACTs): Fears of widespread drug resistance].
Malaria treatment with ACTs (Artemisinin-based Combination Therapies), combining a chemical derivative of artemisinin, and a partner drug has, for more than 15 years, produced a notable decrease in the mortality in tropical and subtropical areas. However, since 2008, a serious threat has emerged in western Cambodia, where the clinical efficacy of artemisinins has significantly declined, with a delayed parasite clearance rate and high recrudescence rates in the following weeks. ⋯ ACTs remain effective as long as the partner drug retains its activity but more and more clinical failures related to parasite resistance to both resistant parasites in sub-Saharan Africa, the continent most affected by malaria, as was the case in the past with other antimalarial treatments. It is therefore essential to better understand, from phenotypic and genotypic points of view, the mechanisms of resistance developed by the parasite Plasmodium falciparum face artemisinin and its derivatives in order to offer new therapeutic tools.