Accreditation of forensic pathology service: a priviledge or a nightmare?

Forensic experts play a major role in the legal process as they offer professional expert opinion and evidence within the criminal justice system adjudicating on the innocence or alleged guilt of an accused person. In this respect medico-legal examination is an essential part of the investigation process, determining in a scientific way, the cause(s) and manner of unexpected and/or unnatural death or bringing clinical evidence in case of physical, psychological or sexual abuse in living people. From a legal perspective, these types of investigation must meet international standards i-e it should be independent, effective and prompt. Ideally the investigations should be conducted by board certified experts in forensic medicine, endowed with a solid experience in this field, without any hierarchical relationship with the prosecuting authorities and having access to appropriate facilities in order to provide forensic reports of high quality. In this respect, there is a need for any private or public national or international authority including non-governmental organisations seeking experts qualified in forensic medicine,to have at disposal a list of specialists working in accordance with high standards of professional performance within forensic pathology services that have been successfully submitted to an official accreditation/certification process using valid and acceptable criteria. To reach this goal the National Association of Medical examiners (NAME) has elaborated an accreditation/certification check-list which should be served as decision-making support to assist inspectors appointed to evaluate applicants. In the same spirit than NAME Accreditation Standards, ECLM board decided to set up an ad hoc working group with the mission to elaborate an accreditation/certification procedure similar to the NAME's one but taking into account the realities of forensic medicine practices in Europe and restricted to post-mortem investigations. This accreditation process applies to services and not to individual practitioners by emphasizing policies and procedures rather than professional performance. In addition the standards to be complied with should be considered as the minimum standards needed to get the recognition of performing and reliable forensic pathology service.

[Épreuves corrigées du programme de "Bacchus" par Jules Massenet]

Épreuves corrigées du programme de "Bacchus". Le programme contient un article de Martial Teneo et un synopsis rédigé par D'Epernon, ainsi que les annotations manuscrites de Massenet. Ancienne cote : "Dossier d'œuvre Bacchus"

Medical and pharmacological direct costs of a 9-week smoking cessation programme.

Background: Medical and pharmacological direct costs of cigarette smoking cessation programmes are not covered by health insurance in several countries despite documented cost-effectiveness. Design: prospective cost identification study of a 9-week programme in Switzerland. Methods: A total of 481 smokers were followed-up for 9 weeks. Socio-demographic characteristics, number of outpatient visits, dosage and frequency of use of nicotine replacement therapy (NRT) as well as date of relapse were prospectively collected. Individual cost of care until relapse or programme end as well as cost per week of follow-up were computed. Comparisons were carried out between the groups with or without relapse at the end of the programme. Results: Of the 209 men and 272 women included, 347 patients (72%) finished the programme. Among them, 240 patients (70%) succeeded in quitting and 107 patients (30%) relapsed. As compared with the group relapsing by the end of the programme, the group succeeding in quitting was more often living in a couple (68% vs. 55%, p = 0.029). Their mean weekly costs of visits were higher (CHF 81.2 ± 6.1 vs. 78.4 ± 7.6, p = 0.001), while their mean weekly costs for NRT were similar (CHF 24.2 ± 12.6 vs. 25.4 ± 15.9, p = 0.711). Mean total costs per week were similar (CHF 105.4 ± 15.4 vs. 103.8 ± 19.4, p = 0.252). More intensive NRT at week 4 increased the probability not to relapse at the end of the programme. Conclusions: Over 9 weeks, medical and pharmacological costs of stopping smoking are low. Good medical and social support as well as adequate NRT seem to play a role in successful quitting.

Attachés d'administration centrale. Constitution initiale des nouveaux corps . [Instruction du 11 avril 1956 des secrétaires d'Etat au Budget et à la présidence du conseil (Fonction publique) relative à la constitution initiale des nouveaux corps d'attachés d'administration. - Annexes. I. Programme des matières à option "Administration générale" du concours spécial prévu à l'article 23 ; II. Textes de base : Loi du 3 février 1953 et du 3 avril 1955. Décret du 16 décembre 1955 portant règlement d'administration publique relatif au statut particulier des attachés d'administration centrale. III. Organisation et programme du concours normal prévu aux articles 5 et 12 du décret du 16 décembre 1955.]

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Exploring the implementation of a medication adherence programme by community pharmacists: a qualitative study

BACKGROUND: Medication adherence has been identified as an important factor for clinical success. Twenty-four Swiss community pharmacists participated in the implementation of an adherence support programme for patients with hypertension, diabetes mellitus and/or dyslipidemia. The programme combined tailored consultations with patients about medication taking (expected at an average of one intervention per month) and the delivery of each drug in an electronic monitoring system (MEMS6?). OBJECTIVE: To explore pharmacists' perceptions and experiences with implementation of the medication adherence programme and to clarify why only seven patients were enrolled in total. SETTING: Community pharmacies in French-speaking Switzerland. METHOD: Individual in-depth interviews were audio-recorded, with 20 of the pharmacists who participated in the adherence programme. These were transcribed verbatim, coded and thematically analysed. Process quality was ensured by using an audit trail detailing the development of codes and themes; furthermore, each step in the coding and analysis was verified by a second, experienced qualitative researcher. MAIN OUTCOME MEASURE: Community pharmacists' experiences and perceptions of the determining factors influencing the implementation of the adherence programme. RESULTS: Four major barriers were identified: (1) poor communication with patients resulting in insufficient promotion of the programme; (2) insufficient collaboration with physicians; (3) difficulty in integrating the programme into pharmacy organisation; and (4) insufficient pharmacist motivation. This was related to the remuneration perceived as insufficient and to the absence of clear strategic thinking about the pharmacist position in the health care system. One major facilitator of the programme's implementation was pre-existing collaboration with physicians. CONCLUSION: A wide range of barriers was identified. The implementation of medication adherence programmes in Swiss community pharmacies would benefit from an extended training aimed at developing communication and change management skills. Individualised onsite support addressing relevant barriers would also be necessary throughout the implementation process.

Développement d'un programme de formation à l'entretien motivationnel

RESUMELe but de ce travail de thèse est de permettre à un public de professionnels de découvrir à travers des enregistrements et un texte d'accompagnement l'entretien motivationnel, approche qui est utilisée depuis une vingtaine d'années et qui a fait ses preuves dans le domaine des habitudes de vie influençant la santé.L'entretien motivationnel est d'une part un esprit. Au moyen d'une attitude non jugeante et non confrontante, il crée un climat de confiance favorable à une démarche de changement. Le thérapeute installe une relation de partenariat dans laquelle la personne est autonome dans ses décisions. Cette attitude ou esprit de l'entretien motivationnel repose sur quatre principes de bases qui favorisent le changement.L'entretien motivationnel utilise d'autre part des techniques qui visent à soulever l'ambivalence d'une personne face à une habitude de vie et à la résoudre. Il existe des techniques essentielles pour construire la motivation au changement et des techniques pour construire un plan permettant à la personne de s'engager dans le changement. Ces techniques sont illustrées dans les enregistrements et par le texte d'accompagnementCe travail de thèse contient tous les éléments nécessaires pour prendre connaissance de l'esprit et des techniques de l'entretien motivationnel. Il est néanmoins indispensable de participer à des séminaires de formation pratique et de bénéficier de supervisions pour apprendre à utiliser l'entretien motivationnel.

A model for organ donation in switzerland, the latin organ donation programme (lodp); an ongoing successful regional initiative

Background: The 1st Swiss federal Transplant Law was finally enforced in July 2007 with the obligation to promote quality and efficiency in transplant procedures. The LODP was created to develop organ and tissue donation in the Latin area of Switzerland covering seventeen hospitals (29% of the population).Methods: Each of the partner hospitals designated at least one Local Donor Coordinator (LDC), member of the Intensive Care team, trained in the organ donation (OD) process. The principal tasks of the LDC's are the introduction of OD procedures, organisation of educational sessions for hospital staff and execution of the Donor Action programme. The LODP has been operational since July 2009, when training of the LDC's was completed, the web-site and hotline activated and the attendance of Transplant Procurement Coordinators (TPC) during the OD process organised.Results: National and regional guidelines are accessible on the LODP website. The Hospital Attitude Survey obtained a 57% return rate. Many of the staff requested training and sessions are now running in the partner hospitals. The Medical Record Revue revealed an increase in the conversion rate from 3.5% to 4.5%. During the 5 years before creation of LODP the average annual number of utilised donors was 31, an increase of 70%, has since been observed.Conclusion: This clear progression in utilised donors in the past two years can be attributed to the fact that partner hospitals benefit from the various support given (hotline, website and from TPC's). Despite the increase in OD within the LODP the Swiss donation rates remain low, on average 11.9 donors per million population. This successful model should be applied throughout Switzerland, but the crucial point is to obtain financial support.

Variation in performance in low-volume mammography screening programmes: experience from Switzerland.

BACKGROUND: Reading volume and mammography screening performance appear positively correlated. Quality and effectiveness were compared across low-volume screening programmes targeting relatively small populations and operating under the same decentralised healthcare system. Except for accreditation of 2nd readers (restrictive vs non-restrictive strategy), these organised programmes had similar screening regimen/procedures and duration, which maximises comparability. Variation in performance and its determinants were explored in order to improve mammography practice and optimise screening performance. METHODS: Circa 200,000 screens performed between 1999 and 2006 (4 rounds) in 3 longest standing Swiss cantonal programmes (of Vaud, Geneva and Valais) were assessed. Indicators of quality and effectiveness were assessed according to European standards. Interval cancers were identified through linkage with cancer registries records. RESULTS: Swiss programmes met most European standards of performance with a substantial, favourable cancer stage shift. Up to a two-fold variation occurred for several performance indicators. In subsequent rounds, compared with programmes (Vaud and Geneva) that applied a restrictive selection strategy for 2nd readers, proportions of in situ lesions and of small cancers (≤1cm) were one third lower and halved, respectively, and the proportion of advanced lesions (stage II+) nearly 50% higher in the programme without a restrictive selection strategy. Discrepancy in second-year proportional incidence of interval cancers appears to be multicausal. CONCLUSION: Differences in performance could partly be explained by a selective strategy for second readers and a prior experience in service screening, but not by the levels of opportunistic screening and programme attendance. This study provides clues for enhancing mammography screening performance in low-volume programmes.