Hervé Maisonneuve

Affaire Wakefield : 12 ans d’errance car aucun lien entre autisme et vaccination ROR n’a été montré

In 1998, a Lancet paper described 12 cases of children with autism, and having been vaccinated (MMR) in the United Kingdom; medias presented the information to the lay public, stating that a link was possible. In 2004, The Lancet published letters responding to allegations against the paper. Later, it was established that no link existed between MMR and autism; few years and many publications were necessary to conclude to the absence of evidence. In 2010, the General Medical Council published a report against Dr Wakefield, first author of the 1998 paper, and showing that the children hospital records did not contain the evidence; hospital records differed from the published paper; the Lancet retracted the 1998 paper. In 2011, Brian Deer, a journalist, published the complete story in theBMJ: in 1996, Wakefield was approached by lawyers representing an anti-vaccine lobby, and they supported the Wakefield research. Dr Wakefield left England; in 2012 he works in Texas, USA, for anti-vaccine lobbies.

Mise au pointAffaire Wakefield : 12 ans d’errance car aucun lien entre autisme et vaccination ROR n’a été montréWakefield's affair: 12 years of uncertainty whereas no link between autism and MMR vaccine has been proved

In 1998, a Lancet paper described 12 cases of children with autism, and having been vaccinated (MMR) in the United Kingdom; medias presented the information to the lay public, stating that a link was possible. In 2004, The Lancet published letters responding to allegations against the paper. Later, it was established that no link existed between MMR and autism; few years and many publications were necessary to conclude to the absence of evidence. In 2010, the General Medical Council published a report against Dr Wakefield, first author of the 1998 paper, and showing that the children hospital records did not contain the evidence; hospital records differed from the published paper; the Lancet retracted the 1998 paper. In 2011, Brian Deer, a journalist, published the complete story in theBMJ: in 1996, Wakefield was approached by lawyers representing an anti-vaccine lobby, and they supported the Wakefield research. Dr Wakefield left England; in 2012 he works in Texas, USA, for anti-vaccine lobbies.

Defining and assessing the competence of health care professionals in France

Introduction: During the past decade, the public, health care professionals, and governments have shown much interest in ensuring that professionals, specifically physicians, are skilled in their work and competent in managing health care organizations. The need to assess competence in the health care sector was explored, with the aim of proposing a policy for monitoring and assessing competence during active professional life. Methods: A literature search and semistructured interviews were conducted. The 16 health care professions listed in the French health care code were included. The main questions were: What is your organizations definition of competence? What are the principal elements that define competence in health care activities? How can a system for assessing competence be implemented? Which methods for such a system are most appropriate, based on foreign experiences? Who are the players in the field of competence? And how can organizations participate in monitoring competence? Results: 265 people representing 148 French organizations were interviewed. Competence in health care should be defined as follows: “professional competence is based on the initial diploma, the implementation of effective continuing education, a minimal professional activity and a regular peer review process.” There was an agreement on the basic elements of competence, on the responsibilities of public institutions and professional organizations, and on the need to work together. Discussion: We have shown that in France health care professionals would like to have a better system that allows them to exchange more information on the main health care issues; this is a serious requirement for most professionals.

Continuing Medical Education and Professional Development in the European Union

Continuing medical education (CME) and its broader term continuing professional development (CPD) are indispensable as part of lifelong learning and may be regarded as equally or more important than undergraduate and postgraduate medical education. Pharmaceutical medicine occupies common ground between the clinical and healthcare professions, pharmaceutical industry and government, and thus, the same principles are applicable. However, the global status of CME/CPD education in pharmaceutical medicine is alarming. Surveys conducted among pharmaceutical medicine associations from 22 countries and pharmaceutical physicians in the US showed that a relatively low number of CME/CPD activities are developed across countries, a high percentage of pharmaceutical physicians lack formal postgraduate education in pharmaceutical medicine and, additionally, training needs in basic knowledge areas were detected. It is evident that further education efforts are necessary. The CME system has many variations across countries. The CME/CPD model, including credits or hours, is the currency by which regulatory bodies often assess competence all over the world. Accreditation systems have been developed primarily in the US and Europe in an attempt to self-regulate and advance practice standards, as well as to respond to environmental pressures for advancement of healthcare quality and insulation of any commercial influence on education. Initiatives for a European and/or global CME harmonization have been developed. However, the major problem is that the various CME systems are very different and fragmented. In spite of the tremendous amount of resources spent on maintaining and upgrading physicians’ knowledge and skills, the effectiveness of CME in producing changes in practice has been questioned. It has been argued that CME programmes, as currently practiced, do not adequately focus on improving clinical performance and patient health outcomes. The emphasis is put on measuring acquired knowledge based on training hours, instead of assessing competences and skills as a result of professional development. A new CME/CPD outcomes-based model for performance improvement through individualized and standardized education has been proposed, including physician’s self-assessment, self-reflection and practice-based learning. PharmaTrain is a public private partnership sponsored by the EU’s Innovative Medicines Initiative including 24 universities, 13 learned societies/associations and several partner training organizations. PharmaTrain aims to provide courses that are designed to meet the needs of pharmaceutical physicians and other professionals working in medicines development (basic diploma, masters and CME/CPD). The PharmaTrain CPD platform will include diploma and master extension and elective modules, both course based and standalone, aimed to facilitate lifelong learning. The successful development and use of the PharmaTrain CPD platform provides a valuable new opportunity to meet the current standards and expectations for CME/CPD posed by stakeholders and society at large.

Publication in 6 rehabilitation professions: a five-year professional-based bibliometric overview

Evidence-based medicine is considered as mandatory especially in the field of drugs evaluation but is expanding to other fields such as surgery and medical devices. There is a general perception that EBP is not well developed in rehabilitation professions. Although needed, little is known about clinical research in rehabilitation professions: Are they any publication? What kind of research is published? Are publications indexed in the main database? RECLIP study therefore proposed to answer these questions through a bibliometric overview for 6 rehabilitation professions. A literature search was performed in Pubmed, Cochrane, Pedro, Pascal, Web of Sciences and OTseeker by rehabilitation professionals. The inclusion criteria were the following: originating from Europe, reporting clinical research, in the field of one of the 6 rehabilitation professions (audiology, occupational therapy, physiotherapy, speech therapy, orthoptics, psychomotricity), and published between 2007 and 2011. When the search resulted in more than 300 references, a sample of 300 references was drawn. After verification of inclusion criteria, articles were assessed for the publication language, indexation on Pubmed, impact factor and methodology. Among the retrieved references, 25% truly reported European clinical research in the rehabilitation field. The 5 European countries that published the most in rehabilitation field were United Kingdom, Sweden, Netherlands, Germany and France. Concerning methodology, repartition between descriptive, analytic and interventional studies varied greatly according to professions (p value <0.0001). Speech therapy had the most interventional pattern with 89% of publication being interventional followed by physiotherapy and audiology, on the opposite orthoptics was at less than 20%. This first bibliometric overview highlights the fact that there might be a lack of comparative research and that bibliographic searches are not adapted for rehabilitation professions, meaning that practices might not always be based on evidence, but rather on experience. Efforts should be made on indexation, and rehabilitation schools should focus on highlighting research to their students.

L'expertise scientifique en médecine

La recherche de qualite dans le systeme de sante est un objectif commun des professionnels, des decideurs et des usagers. L’evaluation des technologies medicales et la formalisation de l’etat des connaissances scientifiques en medecine sont deux demarches ayant pour objectif l’amelioration de la prise de decision pour les autorites publiques et pour les professionnels de sante et usagers. L’innovation ne devrait pas etre mise en cause par les procedures d’evaluation, ni par les divers liens d’interets des membres des groupes de travail, y compris des experts. L’education des acteurs, dont les enseignants et decideurs, doit ameliorer la qualite de l’expertise scientifique en medecine.