Éditeur(s) : HAL CCSD
Résumé : International audience
Association internationnale de pédagogie universitaire
Louvain-La-Neuve, Belgium

hal-01620750
https://hal.univ-antilles.fr/hal-01620750

Éditeur(s) : HAL CCSD
Résumé : International audience
New guidelines have been produced by the CNSF and the CNGOF regarding the use of oxytocin after spontaneous onset of labor in France. This clinical practices were designed to redefine the normal and abnormal obstetrical labor; specify the indications, dosage, procedures, and effects of oxytocin administration; and describe the adverse maternal and perinatal effect associated with oxytocin administration.
31st International Confederation of Midwives (ICM) trienal congress
Toronto, France

Droits : http://creativecommons.org/licenses/by-nc/
hal-01564458
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01564458
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01564458/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01564458/file/Poster%20CNSF%20pour%20ICM%20Toronto%20-%20Juin%202017.pdf

Éditeur(s) : HAL CCSD
Résumé : International audience

Background. Projections of medical demography show a decrease of number of doctors who practice in a rural setting and a low amount of general practitioners’ facilities.

Aim. To explore residents’ career choices and to determine their terms to settle in rural areas.
Methods. Qualitative study by groups interviews in five French cities with total of 33 residents. Thematic analysis was performed using the NVivo® software.
Results. Personal life strongly influenced residents’ career choices with a strong desire of free time. Residents considered working among a team rather than in a traditional group practice. They were interested by a practice in rural setting but countryside perceived as too far from urban centres and lacking of access to services. They also imagined the practice conditions as difficult and solitary. Many residents intended practicing in a “semi-rural” setting, the description of which could match with a significant part of the rural area.
Conclusion. If this declared craze for practice in “semi-rural” setting was confirmed, forecasts for some rural areas could be relativized. Public authorities’ attention should then be focused on rural areas far from urban centres and on territories characterized by lonesome medical practice.

Contexte. Les projections en termes de démographie médicale montrent une diminution du nombre de médecins exerçant en zone rurale, avec un faible nombre d’installations.
Objectif. Explorer les souhaits d’exercice des internes et recueillir leurs conditions pour exercer en zone rurale.
Méthode. Étude qualitative par entretiens collectifs dans cinq villes de France auprès de 33 internes. L’analyse thématique a été réalisée à l’aide du logiciel NVivo®.
Résultats. La vie personnelle influençait fortement les souhaits d’exercice, avec un désir de préserver du temps libre. Les internes envisageaient un exercice en équipe, au-delà de l’exercice de groupe traditionnel. Ils étaient intéressés par l’exercice en milieu rural, mais le territoire rural leur apparaissait sans accès aux services et très éloigné des pôles urbains. Ils se représentaient également des conditions d’exercice difficiles et solitaires. De nombreux internes se projetaient dans un exercice en « semi-rural », dont la description pourrait correspondre à une partie non négligeable de l’espace rural.
Conclusion. Si cet engouement déclaré pour l’exercice en semi-rural venait à se confirmer, ces projections concernant certaines zones rurales pourraient être relativisées. L’attention des pouvoirs publics devrait alors se concentrer sur les zones rurales éloignées des pôles urbains et les territoires marqués par un exercice médical solitaire prédominant.

ISSN: 0998-3953

hal-01654623
https://hal.archives-ouvertes.fr/hal-01654623
OKINA : ua16504

Éditeur(s) : HAL CCSD
Résumé : International audience
Idiopathic pulmonary fibrosis (IPF) is the most frequent chronic idiopathic interstitial pneumonia in adults. The management of rare diseases in France has been organised by a national plan for rare diseases, which endorsed a network of expert centres for rare diseases throughout France. This article is an overview of the executive summary of the French guidelines for the management of IPF, an initiative that emanated from the French National Reference Centre and the Network of Regional Competence Centres for Rare Lung Diseases. This review aims at providing pulmonologists with a document that: 1) combines the current available evidence; 2) reviews practical modalities of diagnosis and management of IPF; and 3) is adapted to everyday medical practice. The French practical guidelines result from the combined efforts of a coordination committee, a writing committee and a multidisciplinary review panel, following recommendations from the Haute Autorité de Santé. All recommendations included in this article received at least 90% agreement by the reviewing panel. Herein, we summarise the main conclusions and practical recommendations of the French guidelines.
Eur Respir Rev

hal-01063982
https://hal.archives-ouvertes.fr/hal-01063982
DOI : 10.1183/09059180.00001814
PUBMED : 24881074

Éditeur(s) : HAL CCSD
Résumé : National audience
Objectives To define the different stages of spontaneous labour. To determine the indications, modalities of use and the effects of administering synthetic oxytocin. And to describe undesirable maternal and perinatal outcomes associated with the use of synthetic oxytocin. Method A systematic review was carried out by searching Medline database and websites of obstetrics learned societies until March 2016. Results The 1st stage of labor is divided in a latence phase and an active phase, which switch at 5 cm of cervical dilatation. Rate of cervical dilatation is considered as abnormal below 1 cm per 4 hour during the first part of the active phase, and blow 1 cm per 2 hours above 7 cm of dilatation. During the latent phase of the first stage of labor, i.e. before 5 cm of cervical dilatation, it is recommended that an amniotomy not be performed routinely and not to use oxytocin systematically. It is not recommended to expect the active phase of labor to start the epidural analgesia if patient requires it. If early epidural analgesia was performed, the administration of oxytocin must not be systematic. If dystocia during the active phase, an amniotomy is recommended in first-line treatment. In the absence of an improvement within an hour, oxytocin should be administrating. However, in the case of an extension of the second stage beyond 2 hours, it is recommended to administer oxytocin to correct a lack of progress of the presentation. If dynamic dystocia, it is recommended to start initial doses of oxytocin at 2 mUI/min, to respect at least 30 min intervals between increases in oxytocin doses delivered, and to increase oxytocin doses by 2 mUI/min intervals without surpassing a maximum IV flow rate of 20 mUI/min. The reported maternal adverse effects concern uterine hyper-stimulation, uterine rupture and postpartum haemorrhage, and those of neonatal adverse effects concern foetal heart rate anomalies associated with uterine hyper-stimulation, neonatal morbidity and mortality, neonatal jaundice, weak suck/poor breastfeeding latch and autism. Conclusion The widespread use of oxytocin during spontaneous labour must not be considered as simply another inoffensive prescription without any possible deleterious consequences for mother or foetus. Conditions for administering the oxytocin must therefore respect medical protocols. Indications and patient consent have to be report in the medical file. © 2016 Elsevier Masson SAS
Revue Sage - Femme

hal-01467543
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01467543
DOI : 10.1016/j.sagf.2016.11.006