Contrôle de qualité centralisé en ostéodensitométrie

As any instrument, osteodensitometers may be subject to variations and drifts related to changes in their working conditions (variation of temperature or of electric alimentation or wear of some components etc.), so it is necessary to control them. This is proposed by the manufacturers on the basis of a daily scan of phantoms and visual examination of the results. However these procedures are not sufficient to detect early changes. So like in multicenter studies, the Grio (Groupe de recherche et d'information sur les ostéoporoses) recommend a Centralised Quality Control to verify independantly and interactively the validity of the measures. Practically it consists of testing the precision (exactitude) of the machine once a year with standards of known density. Moreover every day, after scanning of the phantom, the user has to transfer the results to a specific file. The latter analyses the data with statistical tests: Shewhart rules and Cusum analysis allowing detection early of dysfunction. A monthly validation of this procedure is recommended by sending the file the QC Center via internet. If a problem is discovered the user is invited to contact the QC Center and the maintenance service. This Centralised Quality Control is part of a more global Quality System in order to respect a future mandatory policy.     

Contrôle de qualité en IRM : motivations,méthodes et pratiques

The possible motivations of quality assessment of MR scanners are exposed : comparison or reception of MR equipments, follow-up of technical performances, comparative study of image sequences… The technical parameters concerning the image quality are listed, as well as the measurement techniques of these parameters and their influence on the diagnostic capabilities of the scanner. Examples of protocols and of phantoms are described. An overview of the legal regulations concerning the quality assessment puts in prospect the future obligations.     

L’engagement dans le don de plasma : étude des déterminants chez des donneurs réguliers en plasmaphérèse

The purpose of this study, based on the Theory of planned behavior, is to identify and ultimately better understand what determines the fidelity and the regularity of donors committed in plasmapheresis donation. This qualitative study is a primary stage to establish a classification of donors in a French socio-cultural context. For this reason, we have carried out a survey among 16 regular plasmapheresis donors, by way of semi-structured individual interviews at the Établissement français du sang - Brittany. The level of commitment of these regular donors is considered as a level of appropriation. If subjective norms have initially influenced their decision to donate blood, no specific motivation has been highlighted for them to donate plasma except a generally favourable attitude towards the voluntary donation process. The perception of control over their environment is a variable which played a decisive role in the donor's intention to give, with little cost associated to plasmapheresis donation and recourse to internal causal explanations. A better comprehension of the plasmapheresis donors’ determinants should lead us to a more efficient awareness of new potential donors, thereby enhancing recruitment and retention. Due to the increasing need for plasma-derived products, this study's ultimate issue is closely correlated both with ethical and socio-economic aspects. Following which, after analysing the results, a certain number of recommendations will be made.     

Certification des établissements de santé pour la qualité des soins : le regard évolue sur le risque transfusionnel en ES

The HAS certification for healthcare organisation has gradually introduced the concepts of risk and relevance of care. Related to quality and safety of care, the transfusion act has early been part of the referential, and it seemed interesting to us to observe the changes in the requirements on this topic. After taking into account the regulations and the organization of haemovigilance in the establishment, it is now the search for the factual result for the patient which is the objective of the two main criteria devoted to transfusion. At the same time as the referential, the investigation methods have also evolved: the targeted tracer for Labile Blood Products and Blood-Derived Medicines allows a more detailed analysis geared towards the effective implementation of good transfusion practices. In conclusion, certification has moved from organizing and auditing the process to directly measuring transfusion safety for the patient.     

Comment j’évalue la nécessité d’un dépôt de sang et son type pour un établissement de santé ?

Access to blood components is required for healthcare establishments, particularly for emergency situation and hospital blood bank was often a response to this requirement. However, the complexity of regulation and economic pressures lead healthcare establishment to review regularly their need for a blood bank. This assessment requires analysis of need for transfusions in terms of delay, quantity and clinical situations to which they must respond. When a blood bank is required, three kinds could be under consideration: emergency blood bank, intermediate blood bank and issuance blood bank. According to requirements, advantages and disadvantages of each kind, healthcare establishments would select the most suitable one.