P. Denormandie’s research while affiliated with Institut de France and other places

Objectives The aim of this study was to describe the profile of patients who sought a second medical opinion (SMO) on their therapeutic or diagnostic strategy using nationwide data from a French physician network dedicated to SMOs. Methods An observational cohort study was conducted and the study population consisted of patients residing in France or in the French overseas territories who submitted a request for an SMO through a dedicated platform between January 2016 and October 2020. Patient characteristics were compared between convergent and divergent SMOs. The divergent rate for all patients excluding those with mental diseases were described. Logistic regression was used to estimate the probability of a divergent SMO according to patient characteristics. Results and discussion In total, 1,552 adult patients over several French regions were included. The divergence rate was 32.3 % ( n = 502 patients). Gynecological [Odds Ratio (OR) and 95 % CI: 5.176 (3.154 to 8.494)], urological [OR 4.246 (2.053 to 8.782)] and respiratory diseases [OR 3.639 (1.357 to 9.758)] had the highest probability of a divergent SMO. Complex cases were also associated with a significantly higher risk of a divergent opinion [OR 2.78 (2.16 to 3.59)]. Age, sex, region and profession were not found to be predictive of a divergent second opinion. Conclusions Policymakers should encourage new research on patient outcomes such as mortality and hospitalization rates after a SMO. When proven effective, SMO networks will have the potential to benefit from specific public funding or even play a key role in national healthcare quality improvement programs.

Objet : Cet article vise à proposer une définition et une catégorisation des médecines complémentaires et alternatives (MCA). En effet, l’absence de critères précis de définition limite la compréhension de ce mouvement hétérodoxe et des pratiques qui en sont issues. Objectifs : Ce travail répond à un objectif triptyque visant à apporter des repères, à la fois aux usagers, aux professionnels de santé tout en proposant un référentiel commun pour la recherche. Méthode et matériel : L’élaboration de la définition s’est appuyée sur l’analyse de 62 publications francophones issues des sciences médicales et pharmacologiques, des sciences humaines et sociales ainsi que des sciences politiques et juridiques. La mise en œuvre de la catégorisation a reposé sur l’analyse de 9 classifications nationales et internationales. Après avoir synthétisé l’ensemble des corpus, nous avons procédé à une analyse critique permettant de mettre en lumière les lignes de force et les limites des différentes définitions et classifications. Nous avons ensuite répertorié les principaux éléments structurants des MCA permettant de les conceptualiser (définition) et de les délimiter (catégorisation). Résultats : L’analyse des publications apporte des repères théoriques structurants mais pointe la logique de segmentation des approches conceptuelles et le cloisonnement de la pensée qui en découle. L’analyse des classifications montre une tentative utile d’objectivation de ces recours mais révèle la difficulté d’établir une délimitation hermétique des pratiques. Conclusion : La définition et la catégorisation proposées constituent deux outils utiles pour les usagers, les soignants et les chercheurs, contribuant ainsi à la structuration de ce champ.

Non-pharmacological therapies are now used in many nursing homes often with residents presenting a risk of behavioural disorders. They include music therapy, animal-assisted therapy, physical activity as well as other approaches such as light therapy or aromatherapy. It requires rigorous assessment, the permanent involvement and engagement of residents as well as the staff as part of a compassionate and participative approach. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

The quality of life (QoL) of people with a neurodegenerative pathology is a major issue in the absence of curative treatment. However, validated tools, suitable for patients with major neurocognitive disorders at a severe stage are rare and time-consuming in routine. The aim of this study is to analyze the validity of convergence and the reliability over time of a visual analog scale of well-being named EVIBE (Échelle d'évaluation instantanée de bien-être). The correlation between the EVIBE and another quality of life scale, the Qol-Ad was studied. The correlation with other scales expected to vary with QoL was also studied with the EQ-5D for the measurement of the state of health felt and the NPI-ES for the measurement of behavioral disorders. The EVIBE was administered twice, a few minutes apart, to measure its reliability over time. One hundred and thirty-five patients with Alzheimer's disease or a related disorder were recruited. The results indicated a significant correlation with Qol-AD (r=0.54, p< 0.001). The correlation remained significant when the Mini mental state examination was less than 10 (r=0.39, p=0.05). Correlations between EVIBE and EQ-5D and NPI-ES indicated more mixed results with significant correlation only for the analog part of the EQ-5D (r=0.34, p=0.007). The comparison between the two EVIBEs a few minutes apart showed a satisfactory agreement (r=0.52, p> 0.001). This study shows that EVIBE present a good convergence validity and a good reliability over time to measure the QoL of patients with neurodegenerative pathology even at severe stages of the disease. The scale allows a direct and rapid assessment of the QoL of patients in routine.