Jan

26

Category: Health | Date : January 26, 2015

In a communiqu & eacute; dat & eacute; January 26, 2015, the HAS announced that, after & egrave ; s a r & eacute; & eacute; evaluation of three oral direct action anticoagulants, the Transparency Commission concluded that they do not have the m & ecirc ; effectiveness me & eacute ;, & quot ; especially in the pr & eacute; prevention of stroke c & eacute; r & eacute; braux and embolisms system & eacute; mic in patients with non-valvular atrial fibrillation & quot;.

Furthermore, because of the absence of possibility dé to measure in practice the level of anticoagulation and without an antidote, the authorities & eacute; s position dé sormais these m & eacute; drugs in second & egrave ; me for apr & egrave ; s vitamin K, which remain the treatment of r & eacute; f & eacute ; rence.

Service m & eacute; dical made ​​diff & eacute; rent a m & eacute; dicament & agrave ; other.

At their dé initial evaluation, the Transparency Commission had jug & eacute; the 3 NACO who obtained marketing authorization in France had a m & eacute service dical made ​​significant.

These rivaroxaban and apixaban, which are direct inhibitors of factor Xa clotting, and dabigatran, a direct thrombin inhibitor.

But r & eacute; laying & agrave ; a request from the Ministry of Health & eacute ;, the Transparency Commission has r & eacute; & eacute; won & eacute; mol these dé particles and analyzing data & eacute; es available on each, it has arrived & eacute; e & agrave ; the conclusion that their efficiency & eacute; is not the m & ecirc ; me.

For Eliquis & reg; Xarelto & reg ;, and SMR remains important.

For Pradaxa & reg ;, the SMR mod & eacute; r & eacute;.

The am & eacute; SMR provement of Eliquis & reg; is minor compared to warfarin, but there is no am dé provement of SMR compared to VKA to Pradaxa & reg; and Xarelto & reg;.

Furthermore, the Transparency Commission has reviewed the role of these three NACO in Strat & eacute; gie pr & eacute; prevention of thrombotic events and considered & egrave ; re, in the & eacute; current state of knowledge, they must & ecirc ; be prescribed second & egrave ; for me.

The reason? & quot; The lack of antidote, and the lack of possibility & eacute; measured in current practice the level of anticoagulation & quot;.

Patients on warfarin for which the maintenance of INR dé Sir & eacute; in the target area is not assured & eacute; despite & eacute; proper observance.

Patients who are against the AVK – indicated & eacute; s or poorly tolerated & eacute; r & eacute; s or resent li & eacute constraints ; es & agrave ; monitoring of INR.

Source: Communiqu & eacute; Press the High authority & eacute; sant & eacute; of January 26, 2015.

& quot; The NACO, direct action anticoagulants, not all dé shown & eacute; m & ecirc ; effectiveness me & eacute; & quot ;.

Jan

26

Category: Health | Date : January 26, 2015

R & eacute; r & eacute organization ; bucket of maternity & eacute; s did not start yesterday: d & egrave ; s 1972 a r & eacute rules designed & agrave ; ensure s & eacute; SAFETY & eacute; reinforced & eacute; e & deliveries went icirc ; born a r & eacute; reduction in the number of maternity & eacute; s, that s ‘ & eacute; & agrave rose ; 35.5 % in 1981.

Far from ecirc & ; & eacute ;, be achev this closing movement continued more slowly for 15 years, reaching a new 28% decrease.

Finally, the publication of dé decrees of 9 October 1998 & eacute; tablissant new standards of s & eacute; SAFETY & eacute; and organization of health care delivery has again acc & eacute; l & eacute; r & eacute; deep reorganization of the structure of the offer maternity & eacute; s, whose numbers & eacute; t & eacute; r & eacute; product by a third in 16 years.

& quot; In total, in 10 years, more than two thirds of maternity & eacute; s thus closed & eacute; & quot ;, indicate the report.

At the request of the S & eacute; nat the Court of Auditors men & eacute; a survey & ecirc ; you on r & eacute; op & eacute organizations; r & eacute; es since 2002 to measure the impact of those dé Color & eacute; d & eacute; Decree of difficulty 1998.Des & eacute; s recruitment r & eacute; currentes.

In addition to the r & eacute; drastic reduction in the number of maternity & eacute; s, the Court of rel & egrave Auditors; ve growth in the size of dé establishments and a change in the structure of supply between types of dé establishments.

Above all, it notes that & quot; The effective compliance standards are imperfectly & eacute; es & quot ;, pointing to the great fragility & eacute; the dé demography m & eacute; -union.

& quot; While the numbers of m & eacute; & eacute sp doctors ; cialis & eacute; s in the birth yet never & eacute; t & eacute; also & eacute; lev & eacute; s, m & ecirc ; me as midwives, prospects dé demographic of these occupations are marked & eacute; es, & agrave ; Except for this last & egrave ; re, a great fragility & eacute; & agrave ; term dé sormais NEAR TO & eacute; & quot;.

And the Court of Auditors to point & quot; The disparity & eacute; g & eacute s ; ographic dé j & agrave ; considered dé rable & quot ;, the & quot; Difficult & eacute; s recruitment r & eacute; currentes & quot; and to inqui & eacute; ter of dé parts & agrave ; the massive retirement that & quot; portend a rapid increase of difficulty & eacute; s and corr dé relatively risk they went & icirc ; NEET & quot;.

Small Maternity & eacute; s must be put in conformity & eacute;.

These are more particularly & egrave ; larly the maternity & eacute; s Guyana and Mayotte as well as small & eacute; establishments that are the subject of the main inqui & eacute; studies of the Court of Auditors.

This last & egrave ; re dé crit including & quot; INACH & egrave ; tively of setting conformity & eacute; local & quot; and & quot; insufficient intake & eacute vigilance e to the operating conditions of tr & egrave ; s small maternity & eacute; s & quot ;, recalling that these Derni & egrave ; res obtained by dé derogation allowed to continue their activities & eacute ;, & quot; As they have d & ucirc ; r & eacute; glementairement close & quot;.

For these reasons, it pr & eacute; ommended to close without dé lai those not undertake to put in conformity & eacute; imm & eacute; diate, on behalf of the S & eacute; SAFETY & eacute; pregnant women and children & agrave ; na & icirc ; be.

And the report to sweep the main argument of the retention of small maternity & eacute; s, & agrave ; namely their proximity & eacute; with mothers : time Acc & egrave ; s & agrave ; Motherhood & eacute; did not elongated & eacute; s, and if they remain important in some rural areas, r & eacute; p buckets & eacute; & eacute ;, rinatalit centers p & eacute; rinataux of proximity & eacute; and consultations advanced & eacute; es shall monitor proximity & eacute; effective.

They sugg & egrave ; however, rent to strengthen and launch a survey & ecirc ; you & eacute; pid & eacute; miological to pr & eacute; specify the & eacute; Ventuel between dé remoteness of women in relation to maternity & eacute; s and r & eacute; results d & eacute; cevants of France mati & egrave ; re p & eacute; rinatalit & eacute;.

They recommend also to & quot; better organize the management of pregnancies & agrave ; risk, rein & ccedil ; ant the efficiency & eacute; of r & eacute; p buckets & eacute; rinatalit & eacute; and clarifying the r & OCIRC ; the maternity & eacute; s type III & quot;.

Recourse – growing – & agrave ; these dé establishments is jug & eacute; not optimal, while the monitoring of pregnancies is & quot; Mal insured & eacute; & quot;.

Strengthen the monitoring of pregnant women, pr & eacute; carit & eacute;.

Finally, the Court of Auditors recommends strengthening the monitoring of pregnant women, and more particularly & egrave ; larly that of women in situations of pr & eacute; carit & eacute ;, based on better coordination between m & eacute; City of physicians and m & eacute; hospital doctors.

She notes that in France, Hard & eacute; e s & eacute; day maternity & eacute; is one of the & eacute; lev & eacute; es in Europe, for insufficient occupancy.

R & eacute; Result : & quot; & egrave The financial situation of re Maternity & eacute; s is pr & eacute; Cairo & quot ;, with & quot; & Co ucirc ; ts up & quot; and tariffs & quot; For part d & eacute; connect & eacute; s of these & quot;.

The mod & egrave ; the & eacute; should & Economic ecirc ; be reviewed, including a decline in hard & eacute; e of the average S & eacute; days.

The ball is dé sormais in the court of public authorities, which must take active control of the new r & eacute; organizations, which are av & egrave ; also rent n & eacute; sary that In & eacute; luctables, said the Court of Auditors.