INTRODUCTION The assessment made by the regional council of the Pays de la Loire states a favorable review by the health professionals and Pass referents. What about the beneficiaries? The main objective is to assess the methods and difficulties in using contraception prevention Pass by the eligible youth aware of the device attending school in the Maine-et-Loire. METHOD This is a quantitative, retrospective cohort and descriptive study carried out by individual and anonymous questionnaire. The inclusion criteria are students attending Maine-et-Loire schools who agreed to raise awareness about the Pass. RESULTS 683 students were included. One out of two, girls mainly (P = 0.008), from the state schools and CFA-MFR (Apprentice Training Centers-Rural Family Houses), and from vocational education (P = 0.005) were aware and knew about Pass. 56% heard of it but only 41% of youth had received an explanation. 10% of the youth got hold of the Pass by themselves. 14% used it, mainly to receive contraceptives (condoms) without prescription. 61% of the girls and 44% of the boys felt they did not need it, with a significant difference between genders (P = 10–5). Twice as many girls (11%) as boys thought they could directly asked their general practitioner (GP) for contraceptives or a screening test (P = 0.005). One out of four thought it was easier to use the Pass than going to a CPEF (Family Planning Center), especially for the rural students (P = 0.02). DISCUSSION One should review the collective information given to a population that seems less affected or in need of it. It would be useful to offer new communication mediums that match the youth behaviour, and one that is more explicit so as to help them visiting appropriate referenced medical units and to increase offering this device since this is free of charge for condoms, to encourage young people to have their GP or CEGGID prescribe screening tests and expand the Pass outreach to adults who are over 20.

Objectifs : L’évaluation du Pass prévention contraception (PPC) par le conseil régional des Pays de la Loire expose un bilan favorable du dispositif par les professionnels de santé et référents PPC. Qu’en est-il des bénéficiaires ? L’objectif primaire de cette étude est d’évaluer les modalités et difficultés d’utilisation du PPC par les jeunes éligibles, scolarisés dans les établissements du Maine-et-Loire et sensibilisés au dispositif. Méthode : Il s’agit d’une étude quantitative, de cohorte rétrospective et descriptive par questionnaire individuel, porté et anonyme. Les critères d’inclusion sont les élèves scolarisés dans les établissements du Maine-et-Loire ayant accepté la diffusion du Pass dans leur enceinte. Résultats : Un total de 683 élèves a été inclus. La moitié d’entre eux, essentiellement des filles ( p = 0,008), issues d’établissements publics, du centre de formation pour adultes–maison familiale rurale (CFA-MFR) et des filières professionnelles ( p = 0,005) connaissaient le PPC. Plus précisément, 56 % en avaient entendu parler, mais seulement 41 % avaient bénéficié d’une explication. Un jeune sur dix se procurait seul un PPC ; 14 % l’utilisaient principalement pour une délivrance de contraceptifs sans ordonnance (préservatifs) ; 61 % des filles et 44 % des garçons estimaient ne pas en avoir besoin ( p = 10 –5 ). Deux fois plus de filles (11 %) que de garçons estimaient pouvoir s’adresser directement au médecin traitant ( p = 0,005). Un sur quatre pensait qu’il était plus facile d’utiliser le PPC que d’aller au centre de planification et d’éducation familiale (CPEF), surtout pour les ruraux ( p = 0,02). Discussion : L’information collective donnée au sein d’une population souvent peu concernée ou non demandeuse mériterait d’être réinterrogée. Il conviendrait de proposer de nouveaux supports de communication en adéquation avec les comportements des jeunes, mais aussi plus explicites, afin d’orienter ce public vers des professionnels libéraux référencés et d’accentuer les propositions du dispositif, avec pour objectif : une absence d’avance de frais pour les préservatifs, une incitation à pratiquer des tests de dépistage par le médecin traitant ou aux centres gratuits d’information, de diagnostic et de dépistage (Ceggid) et un élargissement de la diffusion du Pass aux majeurs de plus de 20 ans.

Context. Being well-informed on risks specific to their destinations is a mandatory preliminary for all travellers. Aim. To assess the existence of advice regarding serious risks in the care pathway prior to travelling. Methods. Descriptive observational study including French patients repatriated for health reasons between 2014 and 2017. A questionnaire was given in person or sent by e-mail to collect information. Results: Three hundred and twelve responses were collected. Patients were mostly informed about infectious risks (40 %), risks of accidents (30 %), of assault (21 %), cardiovascular and neurological risks (12 %) and psychiatric risks (5 %). Half of the patients consulted their general practitioner before their departure. Conclusion. Travelers are not sufficiently aware of the serious risks related to their trips. Given his knowledge of both travel destinations and his patients' health, the GP seems to be an appropriate source of advice for the future traveller.

Introduction. - Acinetobacter baumanhii is a ubiquitous pathogen resistant to desiccation and responsible for healthcare-associated infections (HAI), especially in intensive care units (ICU) where it is responsible for 5-10% of HAIs. An A. baumannii outbreak occurred in the ICU of the University Hospital of Angers, France.Objectives. - To describe the A. baumannii outbreak and to evaluate the control measures taken. The secondary objective was to evaluate the impact of the electronic alert system on the incidence of multidrug resistance to antibiotics.Methods. - We performed a descriptive study Of A. baumannii carriers during the outbreak. Case contacts and carriers were described using the epidemic curve and a case synopsis table.Results. - From August 2011 to September 2013,49 patients presenting with an extended-spectrum beta-lactamase-producing A. baumannii infection were identified: thirty-four were colonized and 15 were infected. No death was due to the outbreak. Measures taken were: geographical and technical isolation of patients, dedicated team implementation, contact precaution implementation including hand hygiene measures, appropriate use of gloves, and reinforcement of bio-cleaning procedures.Conclusion. - Some patients were re -admitted to hospital while still being carriers; this could explain epidemic peaks. The immersion mission of the hygiene nurse contributed to answering healthcare workers' queries and led to a better cooperation between the ICU and the hygiene team. (C) 2017 Elsevier Masson SAS. All rights reserved.

Aim. - French women often undertake diets, even in the absence of overweight. This transversal quantitative study aimed at providing a status on weight loss practices, among adults present in general practitioners' waiting room. An other objective of this study was to capture patients' expectations regards to the role of their GP in the weight follow-up.Method. - Self-administered questionnaires were distributed to volunteers and recovered from April 17th till June 27th, 2014, in the region of Pays de la Loire. They were analysed in a quantitative way.Results. - Thirty-six per cent of the 1026 participants have recently been on a diet, often high-protein based diet or Weight Watchers diet. These are mostly women (84%), with normal weight (30%), for aesthetic reasons and without medical follow-up (for 71% of them). Few participants use medication, fasting, smoking and vomiting to lose weight. Twenty-two per cent don't practice any sport. The best placed people to help in weight management, listed in descending order, are the dietician, the nutritionist, the family doctor and the partner. Three fourths of the population considers that weight follow-up is under the responsibility of general practitioners. However, 62% don't speak about their weight to their doctor. Thirty-nine per cent expect him or her to spontaneously raise the weight issue. The main obstacles invoked by the general practitioner to help with weight issues are the challenges linked to a regular follow-up and too short consultations.Conclusion. - As diets are damageable to health (ANSES 2010), it remains essential for our society to fight against the cult of thinness that generates "excessive concerns about one's weight". GP have to promote healthy weights among normal-weighted subjects and to inform about the risks associated with these self-prescribed restrictive practices. (C) 2015 Societe francaise de nutrition. Published by Elsevier Masson SAS. All rights reserved.

Les Françaises entreprennent souvent des régimes amaigrissants, ce en l’absence de surpoids. Cette étude transversale quantitative consiste en un état des lieux des pratiques d’amaigrissement auprès de sujets majeurs présents en salle d’attente de cabinet de médecine générale. Un autre objectif est d’identifier le rôle attribué au médecin généraliste (MG) dans le suivi pondéral. Des autoquestionnaires ont été distribués aux volontaires et recueillis du 17 avril au 27 juin 2014, dans la région Pays de la Loire. Ils ont été analysés de manière quantitative. Trente-six pour cent des 1026 participants ont fait un régime amaigrissant dernièrement, souvent hyperprotéiné ou Weight Watchers. C’étaient surtout des femmes (84 %), de poids normal (30 %), pour l’esthétisme et sans suivi médical (pour 71 %). Peu de participants utilisaient les médicaments, le jeûne, le tabac ou les vomissements pour maigrir. Vingt-deux pour cent ne pratiquaient aucun sport. Les personnes ressources identifiées pour aider à gérer son poids étaient par ordre décroissant, la diététicienne, le nutritionniste, le MG et le conjoint. Trois quarts des répondants estimaient que le suivi pondéral était une des fonctions des MG. Pourtant, 62 % ne parlaient pas de leur poids à leur médecin. Trente-neuf pour cent attendaient une sollicitation spontanée sur ce sujet. Les principaux freins invoqués à ce manque de suivi auprès du MG étaient la difficulté d’un suivi régulier et des consultations trop courtes. Vu les dangers des régimes amaigrissants pour la santé (ANSES 2010), il est important de lutter contre le culte de la minceur qui engendre une « préoccupation excessive à l’égard du poids ». Les MG doivent contribuer à la promotion du poids-santé et informer sur les risques liés à ces pratiques restrictives auto-prescrites. French women often undertake diets, even in the absence of overweight. This transversal quantitative study aimed at providing a status on weight loss practices, among adults present in general practitioners’ waiting room. An other objective of this study was to capture patients’expectations regards to the role of their GP in the weight follow-up. Self-administered questionnaires were distributed to volunteers and recovered from April 17th till June 27th, 2014, in the region of Pays de la Loire. They were analysed in a quantitative way. Thirty-six per cent of the 1026 participants have recently been on a diet, often high-protein based diet or Weight Watchers diet. These are mostly women (84%), with normal weight (30%), for aesthetic reasons and without medical follow-up (for 71% of them). Few participants use medication, fasting, smoking and vomiting to lose weight. Twenty-two per cent don’t practice any sport. The best placed people to help in weight management, listed in descending order, are the dietician, the nutritionist, the family doctor and the partner. Three fourths of the population considers that weight follow-up is under the responsibility of general practitioners. However, 62% don’t speak about their weight to their doctor. Thirty-nine per cent expect him or her to spontaneously raise the weight issue. The main obstacles invoked by the general practitioner to help with weight issues are the challenges linked to a regular follow-up and too short consultations. As diets are damageable to health (ANSES 2010), it remains essential for our society to fight against the cult of thinness that generates “excessive concerns about one's weight”. GP have to promote healthy weights among normal-weighted subjects and to inform about the risks associated with these self-prescribed restrictive practices.

Aim. The purpose of this study was to determine the institutional trajectory and future of young children in child welfare.Materials and methods. A catamnestic study - based on data from the child welfare office in Maine and Loire, France, from 1994 to 2001 - was conducted by a child psychiatrist and a psychologist. Medical, judicial, and educational data (development, health, pathways in child protection services) were collected and analyzed regarding the status of these children 15 years later, adding information gathered by interviewing the child welfare and foster family consultant.Results. We included 128 children admitted to the child welfare office before 4 years of age. Admission to the child welfare system suffers from care delays (a mean of 13.1 months between the first child protection referral and placement) with an average entry age of 17 months and frequent cases of child a. buse (e.g., seven Silverman syndrome cases). The physical and mental health status of these children was poor (poorly monitored pregnancies, prematurity, low birth weight). More than one third of the children had growth failure at admission, with catch-up in half of the cases. The average length of stay in the child welfare system was 13.2 +/- 4.6 years. At the end of the follow-up, there were specific measures to safeguard vulnerable adults: "young adult" (24 cases), "major protection" (eight cases) and "disabled living allowance" (nine cases). One hundred and sixteen children suffered from psychiatric disorders at entry and 98 at the end. The general functioning of children as assessed by the Children's Global Assessment Scale (CGAS) showed a statistically significant improvement. One out of two young adults showed problems integrating socially with chaotic pathways: many foster placements, unsuccessful return to the family, and academic failures.Conclusion. The clinical situations of children in the child welfare office and their long-term progression confirm the importance of this public health problem. Although the measures can greatly improve their physical and psychological recovery, with evidence of thriving, this remains limited: only a few of these children are well integrated socially and academically. (C) 2015 Elsevier Masson SAS. All rights reserved.

Le but de cette étude était de connaître la trajectoire institutionnelle et le devenir de jeunes enfants admis dans une structure d’aide sociale à l’enfance (ASE). Une étude catamnestique des dossiers archivés de 1994 à 2001 a été menée par un pédopsychiatre et une psychologue clinicienne. Elle a porté sur l’évolution clinique des enfants admis avant l’âge de 4 ans au village Saint-Exupéry, foyer de l’enfance du département du Maine-et-Loire. Les données administratives médicales, judiciaires et éducatives (développement, santé physique, situation familiale, parcours à l’ASE) ont été recueillies et analysées à l’aune de leur évolution au sein de la structure. Le recueil a été fait en respectant l’ordre chronologique d’admission afin d’obtenir un recul optimal, tout en complétant par l’interview de référents ASE et des familles d’accueil les informations recueillies sur dossier. Cent vingt-huit enfants ont été inclus. Les délais avant placement avaient été longs (13,1 mois en moyenne après la première alerte) pour un et l’âge moyen d’admission était de 17 mois. La situation sanitaire, physique et psychique des enfants à l’admission était mauvaise : grossesses mal suivies, troubles psychiatriques fréquents, cas de maltraitance avérée dont 7 cas de syndrome de Silverman. tiers des enfants présentait un retard de croissance à l’admission qui a récupéré dans la moitié des cas. La durée moyenne du parcours au sein du dispositif ASE avait été de 13,2–4,6 années. À échéance, 24 mesures « jeune majeur », 8 mesures de protection des majeurs et 9 mesures allocation adulte handicapé (AAH) avaient été prises. Des troubles psychiatriques avaient été notés chez 116 enfants à l’entrée et chez 98 à la sortie du dispositif. Une progression significative du fonctionnement social et scolaire de l’enfant (évalué par l’échelle CGAS pour Children's Global Assessment Scale) a été notée. À l’issue du suivi, un adulte jeune sur deux présentait des difficultés d’insertion sociale, avec parcours chaotique dans de nombreuses familles d’accueil, échecs de restitution et échecs scolaires. La situation clinique des enfants pris en charge à l’ASE et son évolution à long terme confirment les hypothèses de départ sur le retard de prise en charge de ces enfants provenant, dans leur grande majorité, de familles connues et suivies par les services sociaux. Si le placement a permis une amélioration de l’état physique et psychique de ces enfants, avec notamment une récupération staturo-pondérale, nous avons noté à l’issue de cette prise en charge la persistance de troubles psychiques graves nécessitant des mesures de protection sociale ou d’AAH pour un adulte jeune sur cinq. The purpose of this study was to determine the institutional trajectory and future of young children in child welfare. A catamnestic study – based on data from the child welfare office in Maine and Loire, France, from 1994 to 2001 – was conducted by a child psychiatrist and a psychologist. Medical, judicial, and educational data (development, health, pathways in child protection services) were collected and analyzed regarding the status of these children 15 years later, adding information gathered by interviewing the child welfare and foster family consultant. We included 128 children admitted to the child welfare office before 4 years of age. Admission to the child welfare system suffers from care delays (a mean of 13.1 months between the first child protection referral and placement) with an average entry age of 17 months and frequent cases of child abuse (e.g., seven Silverman syndrome cases). The physical and mental health status of these children was poor (poorly monitored pregnancies, prematurity, low birth weight). More than one third of the children had growth failure at admission, with catch-up in half of the cases. The average length of stay in the child welfare system was 13.2 ± 4.6 years. At the end of the follow-up, there were specific measures to safeguard vulnerable adults: “young adult” (24 cases), “major protection” (eight cases) and “disabled living allowance” (nine cases). One hundred and sixteen children suffered from psychiatric disorders at entry and 98 at the end. The general functioning of children as assessed by the Children's Global Assessment Scale (CGAS) showed a statistically significant improvement. One out of two young adults showed problems integrating socially with chaotic pathways: many foster placements, unsuccessful return to the family, and academic failures. The clinical situations of children in the child welfare office and their long-term progression confirm the importance of this public health problem. Although the measures can greatly improve their physical and psychological recovery, with evidence of thriving, this remains limited: only a few of these children are well integrated socially and academically.

Introduction : l’amélioration de la qualité des échanges entre médecine ambulatoire et hospitalière est un problème majeur de la continuité des soins en France. L’objectif de notre étude est d’évaluer la qualité de la communication des informations du parcours de soin des consultants d’un Service des admissions et urgences (SAU) d’un Centre hospitalo-universitaire (CHU) avec les médecins généralistes. Matériels et méthodes : il s’agit d’une étude rétrospective portant sur 602 dossiers de patients ayant consulté le Service des admissions et urgences (SAU) du CHU d’Angers, à partir d’une grille d’évaluation, des courriers de sortie associée à une enquête auprès des médecins généralistes, par questionnaire postal, les interrogeant sur le délai de réception, le contenu et le mode de transmission de ces courriers. Résultats : les points positifs sont l’identification du consultant, la date de la consultation, la présence des résultats des examens complémentaires d’imagerie et la présence d’une conclusion. Les points faibles et axes d’amélioration à mettre en œuvre sont une identification des médecins urgentistes référents présente dans 48 % des courriers, la notification du traitement antérieur absente dans 93 % des cas, le traitement reçu au SAU et de sortie, absent ou incomplet, dans respectivement 78 % et 92 % des courriers, les consignes de suivi données dans 36 % des cas et l’information donnée au patient figurant dans 16 % des courriers. Le délai de réception des courriers est dans 8,5 % des cas ≤ 48 heures, et dans 99 % des cas ≤ 8 jours. Les médecins généralistes sont satisfaits du contenu (90 %) et de la forme (84 %) des courriers du SAU ; toutefois, ils souhaitent des courriers de sortie mieux structurés et plus synthétiques qui soient transmis pour 62 % d’entre eux, par mail sécurisé. Conclusion : la standardisation d’un courrier de sortie, adapté à la pratique du médecin généraliste, remis en main propre au consultant ainsi que son envoi par mail sécurisé semblent être un des axes prioritaires d’amélioration de la qualité du parcours de soin à mettre en place au sein des services d’urgence de l’hôpital.

Le but de notre travail était d’évaluer l’efficacité d’un nouveau système « informatisé » de repérage des patients en situation de précarité arrivant au service d’accueil des urgences (SAU) du CHU d’Angers. Il s’agissait d’une étude rétrospective, comparant les populations repérées et validées par les assistantes sociales (AS) de la Permanence d’accès aux soins de santé (PASS) du SAU comme pouvant bénéficier des actions de la PASS, avant et après la mise en place du repérage informatique au 1er janvier 2011. Le nombre de patients repérés et validés est passé de 101 à 232 depuis l’instauration de l’outil soit une augmentation de 130 %. Au final, 349 patients repérés ont été considérés comme relevant de la PASS et 50 patients repérés comme ne répondant pas aux critères d’inclusion dans la PASS (87 % de patients bien placés). Les actions de la PASS étaient comparables entre les 2 périodes, hormis concernant le recouvrement des droits avec une différence très significative (p = 6,10−6). Il n’existait pas de différence significative pour la domiciliation (p = 0,1). Le nombre de patients repérés a plus que doublé depuis sa mise en service, la majorité des patients repérés sont pris en charge par la PASS et la proportion des patients repérés à tort reste assez faible (13 %). Dans le même temps, l’informatisation du repérage a permis un recrutement plus large de patients notamment des femmes jeunes qui semblaient un peu délaissées avec le dispositif précédent. Le repérage s’est fait majoritairement sur les patients en grande précarité, souvent visible, et a délaissé une forme de précarité moins marquée et plus difficile à démasquer. The purpose of our work was to estimate the efficiency of a new “computerized” system (click PASS) for location of precarious patients arriving at Angers teaching hospital emergencies. It is a retrospective study comparing patients noticed by the emergencies social staff for being able to benefit from help, before and after the implementation of the new computerized system on January 1st, 2011. Noticed patients’ number increased of 130 % since the instauration of “click PASS system” (101 to 232); 349 noticed patients were considered as raising the PASS (87 % of well placed patients). The services delivered by the emergencies’ social staff were comparable between the two periods except the rights covering, with a very significant difference (P = 6.10-6). There was no significant difference for out coming (P = 0.1). Noticed patients’ number increased more than two-fold since the new system starting. The proportion of wrongly noticed patients remained rather low (13 %). At the same time, the location computerization allowed new patients, in particular young women. The location was mainly made among patients in big precariousness, often visible, and not among less marked precariousness, more difficult to unmask.

Introduction. - Lyme borreliosis (LB) is an emerging arthropod-borne disease the diagnosis of which is made on clinical and biological data. We assessed the Angers University Hospital physicians' management of LB, in case of positive serology, and estimated their compliance to European recommendations (EUCALB).Methods. - We retrospectively included 75 cases with positive ELISA serologies confirmed by Western-Blot, performed at the Angers University Hospital between 2008 and 2012.Results and discussion. - There were 4 cases of early localized phase, 26 of early-disseminated phase (including 17 cases of neuroborreliosis), and one case of late phase. The curative management complied with EUCALB guidelines in 28 cases out of 31.Conclusion. - Serology remains a reference diagnostic tool for LB, as long as the practitioner is aware of the main clinical and biological criteria. (C) 2014 Elsevier Masson SAS. All rights reserved.

Objective: Medical demography and the geographical distribution of general practitioners (GPs) in the Pays de la Loire Region constitute a challenge to equitable primary care access. The objective of this study was to describe the career projects of Angers general practice residents in 2012 and to assess their knowledge of installation aids and their impact on practice choices.Method :A questionnaire-based declarative study was conducted in April 2012.Results: 204 out of 243 residents (84%) returned the questionnaire. Women represented 62% of responding residents. 56% of residents expressed their desire for predominantly outpatient general practice. A significant determinant in the choice of this type of practice was the voluntary choice of general practice during residency. Group practice was predominantly considered (86%), in semirural areas (60%). The administrative formalities to set up a general practice and the available aids were underestimated by 82% and 83% of residents, respectively. 91 % of residents wanted to receive more information about administrative formalities and 82% considered that these aids could encourage their decision in favour of general practice. Anjou general practice residents appeared to be very attracted by outpatient general practice.Conclusion: This study shows that strategy of early contact with general practice in medical training should be continued. Information concerning the administrative formalities and aids available must be provided during medical training.

INTRODUCTION:Improvement of the quality of exchanges between primary care and hospital medicine is a major challenge for continuity of care in France. The objective of this study was to evaluate the quality of communication of information to general practitioners concerning the management of patients attending a university hospital emergency department.MATERIALS AND METHODS:This retrospective study was based on the medical charts of 602 patients consulting the Angers university hospital emergency department, using an evaluation grid of discharge summaries associated with a survey of general practitioners, by postal questionnaire, concerning the time to reception, the content and the mode of transmission of these discharge summaries.RESULTS:Strong points were patient identification, the visit date, the presence of complementary imaging investigation results and the presence of a conclusion. Weak points and aspects requiring improvement were identification of the emergency physician, indicated in only 48% of discharge summaries, notification of the previous treatment absent in 93% of cases, the treatment received in the emergency department and on discharge was absent or incomplete in 78% and 92% of discharge summaries, respectively, follow-up advice was provided in 36% of cases and the information given to the patient was indicated in 16% of discharge summaries. The time to reception of discharge summaries was < or = 48 hours in 8.5% of cases and < or = one week in 99% of cases. General practitioners were satisfied with the content (90%) and the form (84%) of emergency department discharge summaries; however, they would like to receive better structured and more concise discharge summaries, preferably sent by secure e-mail for 62% of them.CONCLUSION:Standardization of discharge summaries, adapted to the general practitioner's practice, given directly to the patient and sent by secure e-mail appear to be one of the main targets for improvement of the quality of management to be introduced in hospital emergency departments.

Introduction: We conducted a two-month prospective study (8,171 admissions) in the Angers university hospital emergency room to analyse the impact of the referral letter on the initial triage of patients admitted to the emergency room performed by the reception and triage nurse.Methods: We analysed the level of priority of the CIMU triage scale (nurse's classification of emergency room patients), the presenting complaint, and the need for an urgent procedure before and after reading the referral letter and examined the nurse's comments for explanations concerning any triage changes.Results: 1,516 patients arriving with a referral letter (18.5% of admissions) were included and interpretable data were available for 756 of these cases. After reading the referral letter, nurses modified the CIMU triage level for 34 (4.5%) patients, the presenting complaint for 50 (6.6%) patients and eliminated the need for an urgent procedure for 70 (9.3%) patients. No significant difference was observed concerning the choice of the CIMU triage level (p = 0.908). However, changes in triage level were significantly more frequently towards a more urgent category (p = 0.005). Analysis of the nurse's comments showed that these results can be explained by the signs of severity indicated in the referral letter. Certain histories and/or diagnostic hypotheses appeared to lead nurses to eliminate the need for an urgent procedure.Conclusion: In this study, the referring physician's letter had a limited impact on the choice of triage level defined by the nurse on admission to the emergency room except for patients in whom the referral letter mentioned signs of severity, not observed at reception, led the nurse to apply a more urgent triage level. It would be interesting to study the information contained in the referral letter, useful for triage of patients admitted to the emergency room, in order to improve the impact of the referral letter on the quality of triage.

Introduction: We conducted a two-month prospective study (8,171 admissions) in the Angers university hospital emergency room to analyse the impact of the referral letter on the initial triage of patients admitted to the emergency room performed by the reception and triage nurse.Methods: We analysed the level of priority of the CIMU triage scale (nurse’s classification of emergency room patients), the presenting complaint, and the need for an urgent procedure before and after reading the referral letter and examined the nurse’s comments for explanations concerning any triage changes.Results: 1,516 patients arriving with a referral letter (18.5% of admissions) were included and interpretable data were available for 756 of these cases. After reading the referral letter, nurses modified the CIMU triage level for 34 (4.5%) patients, the presenting complaint for 50 (6.6%) patients and eliminated the need for an urgent procedure for 70 (9.3%) patients. No significant difference was observed concerning the choice of the CIMU triage level (p = 0.908). However, changes in triage level were significantly more frequently towards a more urgent category (p = 0.005). Analysis of the nurse’s comments showed that these results can be explained by the signs of severity indicated in the referral letter. Certain histories and/or diagnostic hypotheses appeared to lead nurses to eliminate the need for an urgent procedure.Conclusion: In this study, the referring physician’s letter had a limited impact on the choice of triage level defined by the nurse on admission to the emergency room except for patients in whom the referral letter mentioned signs of severity, not observed at reception, led the nurse to apply a more urgent triage level. It would be interesting to study the information contained in the referral letter, useful for triage of patients admitted to the emergency room, in order to improve the impact of the referral letter on the quality of triage.

Introduction : nous avons realise une etude prospective pendant 2 mois (8 171 admissions) au service des urgences de l’hopital universitaire d’Angers afin d’analyser l’influence du courrier medical sur la priorisation par l’infirmiere d’accueil et d’orientation des patients admis aux urgences (phase initiale de triage).Methodes : nous avons analyse le niveau de priorite de l’echelle de tri CIMU (Classification Infirmiere des Malades des Urgences), le motif de recours, et la necessite d’un geste urgent avant et apres lecture du courrier medical. Nous avons recherche dans les commentaires des infirmieres des explications aux modifications eventuelles.Resultats : 1 516 patients porteurs d’un courrier medical (18,5 % des admissions) ont ete inclus dont 756 avec des donnees exploitables. Apres lecture de la lettre d’admission, les infirmieres ont modifie le niveau de priorite CIMU pour 34 patients (4,5 %), le motif de recours pour 50 patients (6,6 %) et ont supprime la necessite d’un geste urgent pour 70 patients (9,3 %). Il n’existe pas de difference significative concernant le choix du niveau de priorite CIMU (p = 0,908). Cependant, les modifications du niveau de priorite se font significativement plus souvent dans le sens d’une majoration du caractere urgent (p = 0,005). L’analyse des commentaires montre que la mention de signes de gravite rapportes dans le courrier peut expliquer ces resultats. Certains antecedents et/ou hypotheses diagnostiques semblent avoir conduit les infirmieres a supprimer la necessite d’un geste urgent.Conclusion : dans notre etude la lettre du medecin a peu d’influence sur le choix du niveau de priorite fixe a l’admission aux urgences par l’infirmiere a l’exception de patients pour lesquels la mention de signes de gravite dans le courrier, non retrouves a l’accueil, a conduit l’infirmiere a modifier son niveau de priorite dans le sens plus urgent. La connaissance des informations contenues dans le courrier medical, utiles a la priorisation des patients admis aux urgences, nous parait interessante a etudier afin d’ameliorer son influence sur la qualite du tri.

Introduction. The regional sanitary planning is now associated with health care democracy. In 2005, for the setting up of the SROS 3, we conducted a survey in the health area of a french department.Method. Qualitative method based on semi-structured interviews. Thirty three users were interrogated about their relations with the health care system in their local area.Results. The users expressed themselves, in particular regarding transport, basic service of care, interprofessional cooperation, and relationship between patient and health staff. They noticed evolutions of the care system which raised questions for them. They put forward proposals like local meetings of citizens, outside of the context of care.Conclusion. Users and health professionals should learn to know each other for a better understanding, and to exchange information. Solutions adapted to the local environment could emerge, involving microchanges rather than expecting a large reform.

La prise en charge en urgence de patients en fin de vie nécessite de connaître précisément les vœux du patient. Bien que les soins palliatifs se développent depuis une vingtaine d’années en France, il n’existe pas a l’heure actuelle une fiche de transmissions médicales standardisée. Pour répondre à cette problématique ; nous avons mené une étude analytique descriptive a été menée à partir d’un questionnaire – élaboré en 2010 – interrogeant les médecins généralistes libéraux de Mayenne sur l’utilité d’une fiche de transmissions médicales – intitulée « SAMU urgences pallia 53 » – concernant les patients en soins palliatifs. L’étude montre que les médecins déclarent quasi unanimement cette fiche comme importante et utile. Plus de quatre-vingt pour cent des médecins déclarant être mal informés ont souhaité bénéficier d’une nouvelle formation à propos de cette fiche. Le faible taux de réponse ne permet pas de dresser des conclusions sur les pratiques médicales des médecins généralistes libéraux mais apporte des éléments utiles dans un domaine encore peu exploré. Le bilan à un an de la mise en place de la fiche SAMU urgences pallia 53 dans la Mayenne s’avérant positif, une étude sera menée incessamment afin d’évaluer la faisabilité de la mise en place de cet outil dans le département du Maine-et-Loire.