Violence is too often considered an inevitable part of human existence. Physical, psychological a... more Violence is too often considered an inevitable part of human existence. Physical, psychological and behavioural trauma has an impact not only on the health of the individual but also on the healthcare system. Largely perceived as a social problem, violence is also a public health issue. Promoted by the World Health Organisation and developed in France by Prof Henrion, the National Authority for Health and the mission led by Dr. Tursz, the public health dimension of "Violence and health" is now better defined. The Public Health law of 2004 provided for a national plan on "Violence and Health". After an initial action study, we developed a tool to coordinate public actions in this field. The group "For health, against violence in Picardy" was created to implement expert recommendations by building knowledge, promoting training and networking, and developing services to support and guide victims of violence.
Law no. 2004-800 dated August 6, 2004, establishes new legal measures to facilitate live organ do... more Law no. 2004-800 dated August 6, 2004, establishes new legal measures to facilitate live organ donation, in view of the shortage of organs for transplantation. We sought to assess the knowledge of this statute among hospital personnel. We sent an e-mail questionnaire to 1015 persons working at Amiens university hospital center. It contained eleven closed questions (yes/no/don't know) about permissible live organ and tissue donation and two questions requesting personal opinions about live donation. We compared responses according to profession and department. Questionnaires were returned by 245 respondents. The questions for which more than 70% provided correct answers concerned the fundamental principles of bioethics (consent revocable at any time, donations by adults, donations between spouses, bone marrow donations by minors). Fewer than half the respondents knew the correct answers about the new legal measures adopted in the statute (extension of the circle of potential dono...
2020 IEEE International Conference on Big Data (Big Data), 2020
Overcrowding in Emergency Departments (ED) is considered as an international issue, which could h... more Overcrowding in Emergency Departments (ED) is considered as an international issue, which could have adverse impacts on multiple care outcomes such as the length of stay for example. Part of the solution could lie in the early prediction of the patient outcome as discharge or hospitalization. This study applies Deep Learning to this end. A large-scale dataset of about 260K ED records was provided by the Amiens-Picardy University Hospital in France. In general, our approach is based on integrating structured data with unstructured textual notes recorded at the triage stage. The key idea is to apply a multi-input of mixed data for training a classification model to predict hospitalization. In a simultaneous manner, the model training utilizes the numeric features along with textual data. On one hand, a standard Multi-Layer Perceptron (MLP) model is used with the standard set of features (i.e. numeric and categorical). On the other hand, a Convolutional Neural Network (CNN) is used to operate over the textual data. The two components of learning are conducted independently in parallel. The empirical results demonstrated that the classifier could achieve a very good accuracy with ROC-AUC≈0.83. The study is conceived to contribute to the mounting efforts of applying Natural Language Processing in the healthcare domain.
Cardiovascular implantable electronic devices (CIED) are implanted increasingly frequently. CIEDs... more Cardiovascular implantable electronic devices (CIED) are implanted increasingly frequently. CIEDs are indicated for the treatment of bradycardia, tachycardia and heart failure and therefore improve quality of life and life expectancy. CIED can treat ventricular arrhythmias that would be fatal without immediate care. However, CIEDs raise several patient education, medico-legal, and ethical questions that will be addressed in this article. Information is a patient's right, and necessary for informed consent. When implanting a CIED, the patient must be educated about the need for the device, the function of the device, any restrictions that apply postimplant, and postimplant follow-up methods and schedules. This transfer of information to the patient makes the patient responsible. The occupational physician can determine whether a patient wearing a CIED is able to work. Under current French law, patients are not prohibited from working while wearing a CIED. However, access to certa...
Le regime de responsabilite des medecins salaries a ete recemment aligne sur le regime des salari... more Le regime de responsabilite des medecins salaries a ete recemment aligne sur le regime des salaries dans leur ensemble, au travers des arrets du 9 novembre 2004 dont nous allons etudier le contexte, le principe et la portee. Le medecin salarie peut toujours etre poursuivi devant les juridictions penales mais desormais, il beneficie d'une immunite civile. Le medecin qui agit sans exceder les limites de la mission qui lui est impartie par l'etablissement de sante prive, n'engage pas sa responsabilite a l'egard du patient. La responsabilite civile du medecin salarie ne peut etre retenue sur le terrain delictuel (article 1382 et 1384 alinea 5 du Code Civil) qu'en cas de gestes commis en dehors de la mission qui lui a ete confiee par l'etablissement prive de soins. Le contrat medical etant considere comme passe entre la clinique et le patient, l'etablissement prive se retrouve desormais seul responsable sur un fondement contractuel (article 1147 du Code Civil).
Introduction Les epreuves classantes nationales (ECN) permettent de departager les etudiants en s... more Introduction Les epreuves classantes nationales (ECN) permettent de departager les etudiants en sixieme annee de medecine de France en leur attribuant un rang. Ce rang leur permettant de choisir leur specialite et leur ville de formation. Objectifs Etudier la satisfaction des etudiants face a leur choix de specialite et de ville suite aux ECN et analyser les taux de reussite des etudiants concernant leurs objectifs de classement, specialite et ville. Methodes Etude prospective en deux phases, une premiere pre-ECN et une seconde post-ECN et post-choix. Lors des deux phases, les informations ont ete recueillies via des questionnaires informatises anonymises. L’analyse des resultats a ete realisee pour les etudiants ayant participes aux deux phases. Les variables quantitatives sont presentees avec leur moyenne et ecart-type et sont comparees par test de Student. Les variables qualitatives avec leurs effectifs et pourcentages sont comparees par test du Chi2. Resultats Au total, 202 etudiants eligibles, 124 (60,4 %) a la premiere phase, 9 (4,5 %) ont ete perdus de vue. L’analyse a porte sur 115 etudiants (56,9 %) ayant participes aux 2 phases. Pour les etudiants classes dans les 5000 premiers, 49 (90,7 %) se declaraient satisfaits de la specialite obtenue, 52 (96,3 %) de la ville et 42 (77,8 %) du classement. Contre respectivement 47 (77,1 %), 55 (90,2 %) et 24 (39,3 %) chez les etudiants classes apres 5000. Seul le critere classement etait significatif (p Discussion En depit du classement, 83,48 % des etudiants se declarent satisfaits de la specialite et 93,04 % de la ville obtenues. Egalement en depit du classement, 65,22 % ont atteint leur objectif de specialite et 66,09 % leur objectif de ville. Ces resultats s’expliquent par le fait que les objectifs de classement a ces epreuves ne sont pas les memes en fonction des souhaits initiaux. Conclusion Le classement des facultes de medecine aux ECN base tel qu’il l’est aujourd’hui uniquement sur les rangs obtenus est un tres mauvais indicateur. Il serait necessaire de completer cet indicateur par les taux de satisfaction et de realisation des objectifs.
Since March 1st, 2010, French citizens have been able to call on a new legal procedure for defend... more Since March 1st, 2010, French citizens have been able to call on a new legal procedure for defending their rights: the priority preliminary ruling on issues of constitutionality (question prioritaire de constitutionnalité, QPC). If, during a trial, a citizen considers that a provision of the applicable law is inconsistent with the Constitution of the French Republic, he/she may request that the matter be referred to the Constitutional Council. One ofthe first QPCs concerned legislation related to the Perruche jurisprudence. In a ruling on November 17th, 2000, the French Supreme Court of Appeal had granted the child Nicolas Perruche the right to financial compensation for the material costs related to his physical disability (caused by congenital rubella). In response, Article 1 of the Patients' Rights and Quality of Care Act (passed on March 4th, 2002) prohibited the award of compensation to a child "just because he/she has been born [with a disability]", i.e. in "...
French prisoners have health problems that have been inadequately treated before imprisonment. Th... more French prisoners have health problems that have been inadequately treated before imprisonment. This population has insufficient access to the healthcare system. Addictive behaviours, particularly smoking, are widespread. The aim of the study is to evaluate the prevalence of airflow limitation by using a primary care screening method adapted for the correctional facility and its inmates. The screening of airflow limitation using a mobile spirometer is carried out in inmates consulting the primary care unit (UCSA) of Amiens prison. Patients consulting the UCSA between 16 August and 17 October 2006 and providing their consent are included in the study. The criteria for exclusion are: a counter-indication for spirometry, poor compliance with the effort of forced expiry after eight efforts, as well as refusal to take part in the study. The descriptive statistical analysis includes all of the quantitative and qualitative variables. Among the 210 patients included in the sample, only five patients refused to take part in the study. Their mean age was 37 (range: 16-65) and 90% were men. Ninety percent of this population were active smokers. Sixty percent of these smokers would like to quit. The spirometry detected 11% undiagnosed airflow limitation: 11 prisoners suffered from chronic obstructive lung disease and 13 prisoners suffered from asthma. Given the relative youth and high risk nature of these diagnosed patients, the potential for the long or short term aggravation, and a growing recognition of the seriousness of exposure to tobacco, the authors suggest that the systematic screening of inmates for airflow limitation may be used to assist in detecting serious health issues. Along with new French antismoking legislation, this screening may enable primary care workers to better reduce smoking habits in prisons.
Law 98-468 of 17th June 1998 enables hearings for minor victims of aggression or sexual assault t... more Law 98-468 of 17th June 1998 enables hearings for minor victims of aggression or sexual assault to be filmed. This legal procedure can sometimes be traumatic. In the region of Picardie, units dedicated to underage victims have been developed. These units bring together all the relevant professionals in a reassuring environment suitable for children, in order to encourage the child to talk and to help make the whole procedure easier.
La protection de la sante est assuree par l’individu mais egalement par la societe. Le droit a la... more La protection de la sante est assuree par l’individu mais egalement par la societe. Le droit a la protection de la sante est un element structurant des politiques de sante qui ont pour objectif de tendre vers un haut niveau de protection. En droit interne, il trouve son fondement dans le Preambule de la Constitution de 1946. Le principe pose est ainsi utilise comme le fondement d’un droit individuel a la protection de la sante. Ce « droit a la sante » individuel s’exprime notamment au travers de l’exigence croissante envers les professionnels de sante pour qu’ils atteignent le resultat therapeutique escompte, mais egalement envers l’Etat. Un des premiers droits de la personne malade est de pouvoir acceder aux soins. Cet acces depend de plusieurs facteurs notamment la disponibilite des professionnels et des infrastructures. Les soins dispenses se doivent d’etre de qualite et appropries a l’etat de sante du patient, et l’acces aux soins ne doit faire l’objet d’aucune discrimination. C...
Violence is too often considered an inevitable part of human existence. Physical, psychological a... more Violence is too often considered an inevitable part of human existence. Physical, psychological and behavioural trauma has an impact not only on the health of the individual but also on the healthcare system. Largely perceived as a social problem, violence is also a public health issue. Promoted by the World Health Organisation and developed in France by Prof Henrion, the National Authority for Health and the mission led by Dr. Tursz, the public health dimension of "Violence and health" is now better defined. The Public Health law of 2004 provided for a national plan on "Violence and Health". After an initial action study, we developed a tool to coordinate public actions in this field. The group "For health, against violence in Picardy" was created to implement expert recommendations by building knowledge, promoting training and networking, and developing services to support and guide victims of violence.
Law no. 2004-800 dated August 6, 2004, establishes new legal measures to facilitate live organ do... more Law no. 2004-800 dated August 6, 2004, establishes new legal measures to facilitate live organ donation, in view of the shortage of organs for transplantation. We sought to assess the knowledge of this statute among hospital personnel. We sent an e-mail questionnaire to 1015 persons working at Amiens university hospital center. It contained eleven closed questions (yes/no/don't know) about permissible live organ and tissue donation and two questions requesting personal opinions about live donation. We compared responses according to profession and department. Questionnaires were returned by 245 respondents. The questions for which more than 70% provided correct answers concerned the fundamental principles of bioethics (consent revocable at any time, donations by adults, donations between spouses, bone marrow donations by minors). Fewer than half the respondents knew the correct answers about the new legal measures adopted in the statute (extension of the circle of potential dono...
2020 IEEE International Conference on Big Data (Big Data), 2020
Overcrowding in Emergency Departments (ED) is considered as an international issue, which could h... more Overcrowding in Emergency Departments (ED) is considered as an international issue, which could have adverse impacts on multiple care outcomes such as the length of stay for example. Part of the solution could lie in the early prediction of the patient outcome as discharge or hospitalization. This study applies Deep Learning to this end. A large-scale dataset of about 260K ED records was provided by the Amiens-Picardy University Hospital in France. In general, our approach is based on integrating structured data with unstructured textual notes recorded at the triage stage. The key idea is to apply a multi-input of mixed data for training a classification model to predict hospitalization. In a simultaneous manner, the model training utilizes the numeric features along with textual data. On one hand, a standard Multi-Layer Perceptron (MLP) model is used with the standard set of features (i.e. numeric and categorical). On the other hand, a Convolutional Neural Network (CNN) is used to operate over the textual data. The two components of learning are conducted independently in parallel. The empirical results demonstrated that the classifier could achieve a very good accuracy with ROC-AUC≈0.83. The study is conceived to contribute to the mounting efforts of applying Natural Language Processing in the healthcare domain.
Cardiovascular implantable electronic devices (CIED) are implanted increasingly frequently. CIEDs... more Cardiovascular implantable electronic devices (CIED) are implanted increasingly frequently. CIEDs are indicated for the treatment of bradycardia, tachycardia and heart failure and therefore improve quality of life and life expectancy. CIED can treat ventricular arrhythmias that would be fatal without immediate care. However, CIEDs raise several patient education, medico-legal, and ethical questions that will be addressed in this article. Information is a patient's right, and necessary for informed consent. When implanting a CIED, the patient must be educated about the need for the device, the function of the device, any restrictions that apply postimplant, and postimplant follow-up methods and schedules. This transfer of information to the patient makes the patient responsible. The occupational physician can determine whether a patient wearing a CIED is able to work. Under current French law, patients are not prohibited from working while wearing a CIED. However, access to certa...
Le regime de responsabilite des medecins salaries a ete recemment aligne sur le regime des salari... more Le regime de responsabilite des medecins salaries a ete recemment aligne sur le regime des salaries dans leur ensemble, au travers des arrets du 9 novembre 2004 dont nous allons etudier le contexte, le principe et la portee. Le medecin salarie peut toujours etre poursuivi devant les juridictions penales mais desormais, il beneficie d'une immunite civile. Le medecin qui agit sans exceder les limites de la mission qui lui est impartie par l'etablissement de sante prive, n'engage pas sa responsabilite a l'egard du patient. La responsabilite civile du medecin salarie ne peut etre retenue sur le terrain delictuel (article 1382 et 1384 alinea 5 du Code Civil) qu'en cas de gestes commis en dehors de la mission qui lui a ete confiee par l'etablissement prive de soins. Le contrat medical etant considere comme passe entre la clinique et le patient, l'etablissement prive se retrouve desormais seul responsable sur un fondement contractuel (article 1147 du Code Civil).
Introduction Les epreuves classantes nationales (ECN) permettent de departager les etudiants en s... more Introduction Les epreuves classantes nationales (ECN) permettent de departager les etudiants en sixieme annee de medecine de France en leur attribuant un rang. Ce rang leur permettant de choisir leur specialite et leur ville de formation. Objectifs Etudier la satisfaction des etudiants face a leur choix de specialite et de ville suite aux ECN et analyser les taux de reussite des etudiants concernant leurs objectifs de classement, specialite et ville. Methodes Etude prospective en deux phases, une premiere pre-ECN et une seconde post-ECN et post-choix. Lors des deux phases, les informations ont ete recueillies via des questionnaires informatises anonymises. L’analyse des resultats a ete realisee pour les etudiants ayant participes aux deux phases. Les variables quantitatives sont presentees avec leur moyenne et ecart-type et sont comparees par test de Student. Les variables qualitatives avec leurs effectifs et pourcentages sont comparees par test du Chi2. Resultats Au total, 202 etudiants eligibles, 124 (60,4 %) a la premiere phase, 9 (4,5 %) ont ete perdus de vue. L’analyse a porte sur 115 etudiants (56,9 %) ayant participes aux 2 phases. Pour les etudiants classes dans les 5000 premiers, 49 (90,7 %) se declaraient satisfaits de la specialite obtenue, 52 (96,3 %) de la ville et 42 (77,8 %) du classement. Contre respectivement 47 (77,1 %), 55 (90,2 %) et 24 (39,3 %) chez les etudiants classes apres 5000. Seul le critere classement etait significatif (p Discussion En depit du classement, 83,48 % des etudiants se declarent satisfaits de la specialite et 93,04 % de la ville obtenues. Egalement en depit du classement, 65,22 % ont atteint leur objectif de specialite et 66,09 % leur objectif de ville. Ces resultats s’expliquent par le fait que les objectifs de classement a ces epreuves ne sont pas les memes en fonction des souhaits initiaux. Conclusion Le classement des facultes de medecine aux ECN base tel qu’il l’est aujourd’hui uniquement sur les rangs obtenus est un tres mauvais indicateur. Il serait necessaire de completer cet indicateur par les taux de satisfaction et de realisation des objectifs.
Since March 1st, 2010, French citizens have been able to call on a new legal procedure for defend... more Since March 1st, 2010, French citizens have been able to call on a new legal procedure for defending their rights: the priority preliminary ruling on issues of constitutionality (question prioritaire de constitutionnalité, QPC). If, during a trial, a citizen considers that a provision of the applicable law is inconsistent with the Constitution of the French Republic, he/she may request that the matter be referred to the Constitutional Council. One ofthe first QPCs concerned legislation related to the Perruche jurisprudence. In a ruling on November 17th, 2000, the French Supreme Court of Appeal had granted the child Nicolas Perruche the right to financial compensation for the material costs related to his physical disability (caused by congenital rubella). In response, Article 1 of the Patients' Rights and Quality of Care Act (passed on March 4th, 2002) prohibited the award of compensation to a child "just because he/she has been born [with a disability]", i.e. in "...
French prisoners have health problems that have been inadequately treated before imprisonment. Th... more French prisoners have health problems that have been inadequately treated before imprisonment. This population has insufficient access to the healthcare system. Addictive behaviours, particularly smoking, are widespread. The aim of the study is to evaluate the prevalence of airflow limitation by using a primary care screening method adapted for the correctional facility and its inmates. The screening of airflow limitation using a mobile spirometer is carried out in inmates consulting the primary care unit (UCSA) of Amiens prison. Patients consulting the UCSA between 16 August and 17 October 2006 and providing their consent are included in the study. The criteria for exclusion are: a counter-indication for spirometry, poor compliance with the effort of forced expiry after eight efforts, as well as refusal to take part in the study. The descriptive statistical analysis includes all of the quantitative and qualitative variables. Among the 210 patients included in the sample, only five patients refused to take part in the study. Their mean age was 37 (range: 16-65) and 90% were men. Ninety percent of this population were active smokers. Sixty percent of these smokers would like to quit. The spirometry detected 11% undiagnosed airflow limitation: 11 prisoners suffered from chronic obstructive lung disease and 13 prisoners suffered from asthma. Given the relative youth and high risk nature of these diagnosed patients, the potential for the long or short term aggravation, and a growing recognition of the seriousness of exposure to tobacco, the authors suggest that the systematic screening of inmates for airflow limitation may be used to assist in detecting serious health issues. Along with new French antismoking legislation, this screening may enable primary care workers to better reduce smoking habits in prisons.
Law 98-468 of 17th June 1998 enables hearings for minor victims of aggression or sexual assault t... more Law 98-468 of 17th June 1998 enables hearings for minor victims of aggression or sexual assault to be filmed. This legal procedure can sometimes be traumatic. In the region of Picardie, units dedicated to underage victims have been developed. These units bring together all the relevant professionals in a reassuring environment suitable for children, in order to encourage the child to talk and to help make the whole procedure easier.
La protection de la sante est assuree par l’individu mais egalement par la societe. Le droit a la... more La protection de la sante est assuree par l’individu mais egalement par la societe. Le droit a la protection de la sante est un element structurant des politiques de sante qui ont pour objectif de tendre vers un haut niveau de protection. En droit interne, il trouve son fondement dans le Preambule de la Constitution de 1946. Le principe pose est ainsi utilise comme le fondement d’un droit individuel a la protection de la sante. Ce « droit a la sante » individuel s’exprime notamment au travers de l’exigence croissante envers les professionnels de sante pour qu’ils atteignent le resultat therapeutique escompte, mais egalement envers l’Etat. Un des premiers droits de la personne malade est de pouvoir acceder aux soins. Cet acces depend de plusieurs facteurs notamment la disponibilite des professionnels et des infrastructures. Les soins dispenses se doivent d’etre de qualite et appropries a l’etat de sante du patient, et l’acces aux soins ne doit faire l’objet d’aucune discrimination. C...
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