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  • 文章类型: Journal Article
    To provide guidelines regarding parents\' information in case of breech presentation and labour ward organisation for trial of labour in breech presentation.
    Medline and Cochrane Library databases search and review of the main foreign guidelines.
    Information should be in favour of external cephalic version and describe benefits and risks for planned vaginal delivery vs planned caesarean delivery (Professional consensus). Patient should be aware of choice change according to obstetrical context (Professional consensus). Presence of an obstetrician is required at birth as well as immediate assistance of an anaesthesiologist and paediatrician if needed (Professional consensus).
    Information should lead to concerted choice concerning mode of delivery. Labour ward organisation requires presence of an obstetrician at birth and immediate availability of anaesthesiologist and paediatrician.
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  • 文章类型: Journal Article
    The French College of Obstetrics and Gynecology (CNGOF) has released its first comprehensive recommendations for clinical practices in contraception, to provide physicians with an updated synthesis of the available data as a basis for their practice. The organizing committee and the working group adopted the objective methodological principles defined by the French Authority for Health (HAS) and selected 12 themes relevant to medical professionals\' clinical practices concerning contraception. The available literature was screened through December 2017 and served as the basis of 12 texts, reviewed by experts and physicians from public and private practices, with experience in this field. These texts enabled us to develop evidence based, graded recommendations. Male and female sterilization, as well as the use of hormonal treatments not authorized for contraception (\"off-label\") were excluded from the scope of our review. Specific practical recommendations are provided for the management of contraception prescription, patient information concerning effectiveness, risks, and benefits of the different methods, patient follow-up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers, in women after 40, for women at high thromboembolism or cardiovascular risk, and for those at of primary cancer or relapse. The short- and mid-term future of contraception depends mainly on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, regardless of their social and clinical contexts. The objective of these guidelines is to aid in enabling this improvement.
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  • 文章类型: Journal Article
    法国妇产科学院(CNGOF)发布了首个全球避孕临床实践建议,为医生提供可用数据的最新综合,作为他们实践的基础。使用了法国卫生局(HAS)的方法。组委会和工作队成员选择了十二个实际问题。现有文献被筛选到2017年12月,并允许发布基于证据的文献,分级建议。本综述是根据12份已制定的案文印发的,先前由公共和私人诊所的专家和医生审查,有避孕领域的经验。男性和女性绝育,以及使用无避孕标签的激素治疗被排除在本分析范围之外.关于避孕处方管理的具体实践建议,患者信息,包括疗效,风险,以及不同避孕方法的好处,跟进,宫内避孕,紧急避孕,当地和自然的方法,青少年和40岁以后的避孕,血管高风险情况下的避孕,并在提供癌症风险的情况下。避孕的短期/中期未来主要取决于改进现有方法的使用。这包括为用户提供更多信息,并增加妇女获得避孕药具的机会,无论社会和临床背景如何。这是这些建议的目标。
    The French College of Obstetrics and Gynecology (CNGOF) releases its first global recommendations for clinical practice in contraception, to provide physicians with an updated synthesis of available data as a basis for their practice. The French Health Authority (HAS) methodology was used. Twelve practical issues were selected by the organizing committee and the task force members. The available literature was screened until December 2017, and allowed the release of evidence-based, graded recommendations. This synthesis is issued from 12 developed texts, previously reviewed by experts and physicians from public and private practices, with an experience in the contraceptive field. Male and female sterilization, as well as the use of hormonal treatments without contraceptive label were excluded from the field of this analysis. Specific practical recommendations on the management of contraception prescription, patient information including efficacy, risks, and benefits of the different contraception methods, follow up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers and after 40, contraception in vascular high-risk situations, and in case of cancer risk are provided. The short/mid-term future of contraception mostly relies on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, whatever the social and clinical context. That is the goal of these recommendations.
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  • 文章类型: Journal Article
    Based on the best evidence available, we have provided guidelines for clinical practice to target the nature of endometriosis as a disease, the consequences of its natural history on management, and the clinical and imaging evaluation of the disease according to the level of care (primary care, specialized or referral). The frequency of endometriosis is unknown in the general population; endometriosis requires management when it causes symptoms (pain, infertility) or when it affect the function of an organ. In the absence of symptom, there is no need for follow-up or screening of the disease. Endometriosis may be responsible for various pain symptoms such as severe dysmenorrhea, deep dyspareunia, painful bowel movements or low urinary tract signs increasing with menstruation, or infertility. A careful evaluation of the symptoms and their impact on the quality of life should be made. The first-line examinations for the diagnosis of endometriosis are: digital examination and pelvic ultrasound. The second-line examinations are: the pelvic exam by an expert clinician, the pelvic MRI and/or the transvaginal ultrasound by an expert. MRI and ultrasound carrying different and complementary information. Other examinations may be considered as part of the pre-therapeutic assessment of the disease in case of specialized care. Diagnostic laparoscopy may be suggested in case of clinical suspicion of endometriosis whereas preoperative examinations have not proved the disease, it must be part of a management plan of endometriosis-related pain or infertility. During management, it is recommended to give comprehensive information on the different therapeutic alternatives, the benefits and risks expected from each treatment, the risk of recurrence, fertility, especially before surgery. The information must be personalized and take into account the expectations and preferences of the patient, and accompanied by an information notice given to the patient.
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  • 文章类型: Consensus Development Conference
    向活着的捐赠者提供信息首先是法律义务,也是道德义务,更不用说提供医疗保健是必要的。研究表明,有关程序实践方面的信息质量,临床测试和检查的安排,提取干细胞用于捐赠,捐献后的症状,以及医疗团队提供的支持,直接影响捐赠者的体验质量。考虑到这一点,我们小组决定,必须以小册子的形式为捐赠者提供信息支持,以便在法国各地的造血干细胞移植中心提供。2016年9月在里尔,法国,法语国家骨髓移植和细胞治疗协会(SFGM-TC)组织了第7次过敏性造血干细胞移植临床实践协调研讨会。作为这些研讨会的一部分,我们小组共同努力,开发了一个不可或缺的信息基础,这些信息将被纳入小册子,并使用清晰易懂的语言呈现。
    Providing information to living donors is first and foremost a legal obligation as well as an ethical one, not to mention necessary to health care provision. It\'s been shown that quality of information concerning the procedure\'s practical aspects, scheduling of clinical tests and examinations, withdrawing stem cells for the donation, post-donation symptoms, and support provided by healthcare teams, directly impacts the donor\'s quality of experience. Taking this into consideration our group decided it was essential to create an informational support for donors in the form of a booklet to be provided in different hematopoietic stem cell transplant centers across France. In September 2016 in Lille, France, the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) organized the 7th allergenic hematopoietic stem cell transplantation clinical practices harmonization workshops. As part of these workshops, our group worked collectively to develop a basis of indispensable information to be included in the booklet and presented using clear and accessible language.
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  • 文章类型: Journal Article
    在SFGM-TC关于协调临床实践的第六次研讨会系列的背景下,我们的研讨会提出了造血干细胞捐献者和受者的知情同意程序的标准化,从而导致自体或同种异体移植.所有知情同意书均为骨髓或外周干细胞捐献者,和单核细胞/淋巴细胞供体按照常规程序。已纳入自体和同种异体相关或无关成人和儿科移植患者的知情同意书。第一步是提前收集所有法语移植中心常规使用的知情同意书。第二步,一个多学科小组已经重新编写了一个全面的版本。为了了解风险和优势,语言经过仔细考虑和精简。第三步,文本被发送给干细胞移植专家,法国生物医学机构的专家(Averencedelabiomedecine[ABM]),法律专家,法国血液学学会伦理委员会成员和几名移植接受者将进行编辑和校对。
    Within the context of the SFGM-TC\'s 6th workshop series on the harmonization of clinical practices, our workshop proposes a standardization of the informed consent process for hematopoietic stem cell donors and recipients leading up to an autologous or allogenic transplantation. All informed consent was for bone marrow or peripheral stem cell donors, and mononuclear/lymphocyte donors according to usual procedures. The informed consent for autologous and allogenic related or unrelated adults and pediatric transplantation patients have been included. A first step has been conducted for collecting in advance the informed consent forms used routinely in all francophone transplantation centers. In a second step, a comprehensive version has been re-written by a multidisciplinary team. For the purposes of understanding the risks and advantages, language has been carefully considered and streamlined. In the third step, texts were sent to stem cell transplantation experts, experts at the French biomedical agency (agence de la biomédecine [ABM]), law specialists, members of the ethical committee of the French society of hematology and several transplant recipients to be edited and proofread.
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  • 文章类型: Journal Article
    目的:评估产科医生从我们的产妇到法国执业指南的依从性,这些指南涉及向有疤痕子宫病史的孕妇提供的信息。
    方法:2014年6月至8月对医学档案进行观察性回顾性研究,研究对象为妊娠37周后活产的子宫瘢痕妇女。患者的信息必须关注剖腹产史的风险,各种交付模式的收益和风险。
    结果:在758次交付中,研究77例:从怀孕开始随访48例,妊娠中期23例,未随访6例。从一开始随访的患者中,医疗档案上没有关于产后应立即提供的信息的数据,在先入为主的咨询中,以及在怀孕开始时关于瘢痕子宫的风险和分娩方式。在第八个月,有关计划交付模式的收益和风险的信息在45%的文件中被注意到。
    结论:理论上需要给予瘢痕子宫患者的信息在医学档案上很少或不够注意;这可能是由于信息不准确,或缺乏转录的信息,尽管如此。产科文件中的检查表将有助于将疤痕子宫患者提供的信息系统化。
    OBJECTIVE: To evaluate adherence of obstetricians from our maternity to French practice guidelines concerning information to give to pregnant patients with a history of scarred uterus.
    METHODS: Observational retrospective study performed on medical files from June to August 2014 and concerning women with a scarred uterus that gave live-birth after 37weeks of gestation. Information of patients had to concern the risks of a history of caesarean, the benefits and risks of the various delivery modes.
    RESULTS: On 758 deliveries, 77 cases were studied: 48 patients were followed up from the beginning of pregnancy, 23 from the 2nd trimester and 6 were not followed. Among patients followed from the beginning, no data was written on medical file concerning information that should to be given in immediate post-partum, in preconception counseling, and at the beginning of pregnancy about the risks of scarred uterus and the mode of delivery. In the 8th month, information about benefits and risks of the planned delivery mode was noticed in 45% of files.
    CONCLUSIONS: The information that need in theory to be given to the patients with scarred uterus appeared little or insufficiently noticed on medical files; which can be due either to an inaccurate information, or to a lack of transcription of the information nevertheless given. A check-list in obstetrical file would help to systematize the information to provide in scarred uterus patients.
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  • 文章类型: Journal Article
    OBJECTIVE: The authors present the guidelines of the French Society of Oto-Rhino-Laryngology and Head and Neck Surgery (SFORL) on patient information ahead of thyroid surgery.
    METHODS: A multidisciplinary medical team was tasked with a scientific literature review on this topic. The texts retrieved were analyzed by an independent committee. A joint meeting drew up the final guidelines. The strength of the recommendations (grade A, B or C) was based on levels of evidence.
    RESULTS: It is recommended that the results of preoperative exploration and the indications for surgery should be explained to the patient. Patients should be informed as to the type of surgery, surgical objectives, risks and consequences. It is mandatory to obtain the patient\'s written consent before surgery.
    CONCLUSIONS: Appropriate medical information is a critical step in patient management.
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    文章类型: Journal Article
    It is important to supervise health workers in order to maintain and improve their performance and the overall quality of care. In Tanzania, district health management teams are responsible for supervising health centers. Staff in the centers should then supervise dispensaries which are then tasked with supervising village health posts. The Ministry of Health recommends at least two supervision visits per unit per year. In 1987, the Ministry of Health issued the National Guidelines for Supervision (NGS) of health centers and dispensaries to be used by the supervisors of the peripherals health workers. The authors reviewed NGS records in Mpwapwa and Kondoa districts for 1989-92 in their analysis of the supervision process and the appropriateness of the tools for supervision in Tanzania. Neither district has achieved the standard of two visits per year. The supervisory teams varied and the mean active time in the units was four hours. Moreover, the role of the community representatives in supervision is unclear and inconsistent. Those in charge of the health centers and dispensaries are satisfied with the quality of supervision from the district team, but they do not routinely supervise their satellite health units as required by the national guidelines. Study findings demonstrate the merit of periodically reviewing NGS records in the interest of formulating recommendations for improving the supervision process.
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