Gérard Parmentier - Academia.edu (original) (raw)
Papers by Gérard Parmentier
Bulletin Du Cancer, May 1, 2004
The concept of continuous and global care is acknowledged today by all as inherent to modern medi... more The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor communication between the teams, by the administrative difficulties encountered by the teams participating in the supportive care. The working group insists on the fact that the supportive care is not a new speciality. He proposes the creation of units. departments or pole of responsibility of supportive care with a "basic coordination" involving the activities of chronic pain, palliative care, psycho-oncology, and social care. This coordination can be extended, according to the "history" and missions of health care centres. Service done with the implementation of a "unique counter" for the patients and the teams is an important point. The structure has to comply with the terms and conditions of contract (Consultation, Unit or Centre of chronic pain, structures of palliative care, of psycho-oncology, of nutrition, of social care). A common technical organization is one of the interests. The structure has to set up strong links with the private practitioners, the networks, the home medical care (HAD) and the nurses services at home (SSIAD), when they exist, to guarantee the continuity of the supportive care under all its aspects and in order to take into account the…
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2013
Annales Françaises d'Anesthésie et de Réanimation, 1995
Chirurgie ambulatoire : otJ en sommes-nous ? Eldments de r(ponse...
Bulletin du Cancer, 2003
The aim of this study was to check the clinical predictive variables of the variance of the total... more The aim of this study was to check the clinical predictive variables of the variance of the total cost by GHM for patients undergoing chemotherapy. 10 different hospitals registered 537 hospital stays and 1,535 day care sessions. The initial disease, metastases, other pathologies, participation to randomised trial were recorded. Each day health status, pain, stage of the protocol and the drugs, use of catheter, pump or chamber implant were noted. Work was measured separately for physicians and nurses per 24 hours using a visual analogy scale. Lab tests and drugs were recorded for each patient. The cost of the drugs explain 98% of the variance of the total cost for the day care and 50% for the hospitalisations. For the latter, beside the cost of drugs, the length of stay, labor, initial disease, age, pain and associated pathology are predictive variables. According to this results, we conclude that the drugs for chemotherapy should be paid separately. No other change should be made f...
La chirurgie ambulatoire est un concept d'organisation centre sur le patient. C'est une i... more La chirurgie ambulatoire est un concept d'organisation centre sur le patient. C'est une innovation dont le developpement depend des politiques d'accompagnement qui lui sont consacrees. Comme pour toute innovation elle ne peut faire profiter les patients ou la societe de ses bienfaits que dans la mesure ou les conditions de sa mise en œuvre sont respectees. Les definitions internationales reconnues insistent toutes sur son caractere qualifie et substitutif.
Bulletin du cancer, 2003
The aim of this study was to check the clinical predictive variables of the variance of the total... more The aim of this study was to check the clinical predictive variables of the variance of the total cost by GHM for patients undergoing chemotherapy. 10 different hospitals registered 537 hospital stays and 1,535 day care sessions. The initial disease, metastases, other pathologies, participation to randomised trial were recorded. Each day health status, pain, stage of the protocol and the drugs, use of catheter, pump or chamber implant were noted. Work was measured separately for physicians and nurses per 24 hours using a visual analogy scale. Lab tests and drugs were recorded for each patient. The cost of the drugs explain 98% of the variance of the total cost for the day care and 50% for the hospitalisations. For the latter, beside the cost of drugs, the length of stay, labor, initial disease, age, pain and associated pathology are predictive variables. According to this results, we conclude that the drugs for chemotherapy should be paid separately. No other change should be made f...
Bulletin Du Cancer, 2003
Notre objectif etait de mettre en evidence les facteurs predictifs de la variabilite des couts de... more Notre objectif etait de mettre en evidence les facteurs predictifs de la variabilite des couts des sejours pour chimiotherapie afin de justifier une modification de leur prise en charge dans le PMSI. Dix etablissements ont decrit 537 sejours complets et 1 535 sejours de jour. Les donnees recensees concernaient le site tumoral primitif, les localisations secondaires, les pathologies associees, l‘etat general, l‘existence d‘une douleur, la situation therapeutique, les medicaments, leur duree d‘administration, la notion d‘essai therapeutique et l‘usage d‘un catheter, d‘une pompe ou d‘un site implantable. La charge de travail a ete estimee pour chaque categorie de personnel par une echelle visuelle analogique. Le cout du travail a ete calcule a partir des grilles de salaire de la fonction publique, celui des examens par le tarif de remboursement de l‘assurance maladie et celui des medicaments par leur prix d‘achat. Le forfait journalier a ete calcule a partir des donnees de comptabilite...
Douleur Et Analgesie, 2004
Résumé Les concepts de continuité et de globalité des soins sont reconnus aujourd’hui par tous c... more Résumé Les concepts de continuité et de globalité des soins sont reconnus aujourd’hui par tous comme inhérents à la médecine moderne. Un groupe de travail s’est réuni pour proposer des modèles de coordination des soins de support pour toutes les maladies graves dans les différents établissements de soins privés et publics. Les «soins de support» sont: «l’ensemble des soins et soutiens
The concept of continuous and global care is acknowledged today by all as inherent to modern medi... more The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor commu...
Bulletin de l'Académie Nationale de Médecine
Cancer/Radiothérapie
En médecine, en radiothérapie oncologique, comme ailleurs, le principe de qualité n'a de sens que... more En médecine, en radiothérapie oncologique, comme ailleurs, le principe de qualité n'a de sens que s'il est défini. En France comme partout, la radiothérapie a ses forces et ses faiblesses. Comme dans tous les pays, son avenir semble assuré par ses performances en termes de coût/efficacité comme par sa capacité à évoluer du triple point de vue de ses équipements, de ses métiers et de son organisation. Pourtant, la radiothérapie française est en crise. Les professionnels ont vu clair. Depuis plus de dix ans ils rappellent les autorités sanitaires à leurs responsabilités concernant les évolutions démographiques des radiothérapeutes et des physiciens, la rénovation des plateaux techniques, la modernisation des organisations, la promotion de l'évaluation des procédures et des résultats et le développement d'une plus grande équité dans les financements. Mais le retard pris, la mise sous pression des professionnels par l'État, ses services, ses agences et les médias à la suite des récents accidents, sont source de nombreux effets pervers et d'une grande inquiétude. L'accident d'Épinal a été l'initiateur d'un effort de professionnalisation de la gestion des risques, mais aussi d'une période troublée propice à une certaine confusion des esprits, au découragement et aux comportements protecteurs. Les risques ressentis par les professionnels semblent alors surtout provenir des autorités et des médias. Il apparaît que le thème de la qualité est au centre de tous les discours. Sous ce vocable, c'est en fait le respect des procédures liées à l'impératif de sécurité qui est privilégié par l'État et ses représentants. La sécurité apparente semble l'emporter sur la qualité réelle des pratiques. Le temps est donc venu d'une clarification des concepts de qualité et de sécurité, des organisations qui y concourent et de l'élaboration d'une stratégie claire rassemblant l'interprofession. Dans ce contexte, l'implication des sociétés savantes et en particulier de la Société française de radiothérapie oncologique est une nécessité.
Bulletin du cancer, 2004
The concept of continuous and global care is acknowledged today by all as inherent to modern medi... more The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor commu...
Oncomagazine, Aug 1, 2008
Bulletin Du Cancer, Jun 1, 2013
In the French health system, social security is the same for both public and private hospitals re... more In the French health system, social security is the same for both public and private hospitals regardless of their status. In terms of number of patients screened, diagnosed, or treated, independant medicine is the most important sector in the French oncology. The multitude of organizations representing private hospitals or independant oncologists, physicians, radiologists or pathologists have a common organization, the National Union for Private Hospital Oncology (UNHPC). It bases its action on two founding postulates to ensure the quality of the oncology practice : the medical and managerial cultures are complementary and should be articulated ; the quality of organizations is as important as professional competence.
Cancer/Radiothérapie
In medicine, as in oncological radiotherapy, as elsewhere, the precept of quality has no meaning ... more In medicine, as in oncological radiotherapy, as elsewhere, the precept of quality has no meaning if it is not defined. In France as everywhere radiotherapy has its forces and its weaknesses. As in every country, its future seems assured by its character cost effective as by its capacity to make progress in the triple point of view of its equipment, its professions and its organization. However, the French radiotherapy is in crisis. The professionals saw clearly. For more than 10 years they had recalled the medical authorities to their responsibilities concerning the demographic trends for the radiotherapists and the physicists, the renovation of the equipment, the modernization of the organizations, the promotion of the evaluation of procedures and outcomes and the development of a greater fairness in the financings. But the delay taken, the setting under pressure of the professionals by the State, its services, its agencies and the media following the recent accidents cause numerous perverse effects and worried the staff. The accident of Epinal was the starting fact of an effort of professionalisation of the risk management, but also of a disturbed period favourable with a certain confusion of minds, discouragement and protective behaviors. The risks felt by the professionals then seem especially to come from the authorities and the media. It appears that the topic of quality is at the center of all these speeches. Under this vocable, it is in fact the respect of the procedures related to the requirement of security which is privileged by the State and its representatives. The apparent security seems to override the real quality of the practices. Thus, time came for a clarification of the quality and security concepts, of organizations which contribute to it and for the development of a clear strategy bringing together the interprofessionnal actors. In this context, the implication of the College and especially of the Société française de radiothérapie oncologique is a requirement.
Annales Françaises d Anesthésie et de Réanimation
Bulletin Du Cancer, May 1, 2004
The concept of continuous and global care is acknowledged today by all as inherent to modern medi... more The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor communication between the teams, by the administrative difficulties encountered by the teams participating in the supportive care. The working group insists on the fact that the supportive care is not a new speciality. He proposes the creation of units. departments or pole of responsibility of supportive care with a "basic coordination" involving the activities of chronic pain, palliative care, psycho-oncology, and social care. This coordination can be extended, according to the "history" and missions of health care centres. Service done with the implementation of a "unique counter" for the patients and the teams is an important point. The structure has to comply with the terms and conditions of contract (Consultation, Unit or Centre of chronic pain, structures of palliative care, of psycho-oncology, of nutrition, of social care). A common technical organization is one of the interests. The structure has to set up strong links with the private practitioners, the networks, the home medical care (HAD) and the nurses services at home (SSIAD), when they exist, to guarantee the continuity of the supportive care under all its aspects and in order to take into account the…
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2013
Annales Françaises d'Anesthésie et de Réanimation, 1995
Chirurgie ambulatoire : otJ en sommes-nous ? Eldments de r(ponse...
Bulletin du Cancer, 2003
The aim of this study was to check the clinical predictive variables of the variance of the total... more The aim of this study was to check the clinical predictive variables of the variance of the total cost by GHM for patients undergoing chemotherapy. 10 different hospitals registered 537 hospital stays and 1,535 day care sessions. The initial disease, metastases, other pathologies, participation to randomised trial were recorded. Each day health status, pain, stage of the protocol and the drugs, use of catheter, pump or chamber implant were noted. Work was measured separately for physicians and nurses per 24 hours using a visual analogy scale. Lab tests and drugs were recorded for each patient. The cost of the drugs explain 98% of the variance of the total cost for the day care and 50% for the hospitalisations. For the latter, beside the cost of drugs, the length of stay, labor, initial disease, age, pain and associated pathology are predictive variables. According to this results, we conclude that the drugs for chemotherapy should be paid separately. No other change should be made f...
La chirurgie ambulatoire est un concept d'organisation centre sur le patient. C'est une i... more La chirurgie ambulatoire est un concept d'organisation centre sur le patient. C'est une innovation dont le developpement depend des politiques d'accompagnement qui lui sont consacrees. Comme pour toute innovation elle ne peut faire profiter les patients ou la societe de ses bienfaits que dans la mesure ou les conditions de sa mise en œuvre sont respectees. Les definitions internationales reconnues insistent toutes sur son caractere qualifie et substitutif.
Bulletin du cancer, 2003
The aim of this study was to check the clinical predictive variables of the variance of the total... more The aim of this study was to check the clinical predictive variables of the variance of the total cost by GHM for patients undergoing chemotherapy. 10 different hospitals registered 537 hospital stays and 1,535 day care sessions. The initial disease, metastases, other pathologies, participation to randomised trial were recorded. Each day health status, pain, stage of the protocol and the drugs, use of catheter, pump or chamber implant were noted. Work was measured separately for physicians and nurses per 24 hours using a visual analogy scale. Lab tests and drugs were recorded for each patient. The cost of the drugs explain 98% of the variance of the total cost for the day care and 50% for the hospitalisations. For the latter, beside the cost of drugs, the length of stay, labor, initial disease, age, pain and associated pathology are predictive variables. According to this results, we conclude that the drugs for chemotherapy should be paid separately. No other change should be made f...
Bulletin Du Cancer, 2003
Notre objectif etait de mettre en evidence les facteurs predictifs de la variabilite des couts de... more Notre objectif etait de mettre en evidence les facteurs predictifs de la variabilite des couts des sejours pour chimiotherapie afin de justifier une modification de leur prise en charge dans le PMSI. Dix etablissements ont decrit 537 sejours complets et 1 535 sejours de jour. Les donnees recensees concernaient le site tumoral primitif, les localisations secondaires, les pathologies associees, l‘etat general, l‘existence d‘une douleur, la situation therapeutique, les medicaments, leur duree d‘administration, la notion d‘essai therapeutique et l‘usage d‘un catheter, d‘une pompe ou d‘un site implantable. La charge de travail a ete estimee pour chaque categorie de personnel par une echelle visuelle analogique. Le cout du travail a ete calcule a partir des grilles de salaire de la fonction publique, celui des examens par le tarif de remboursement de l‘assurance maladie et celui des medicaments par leur prix d‘achat. Le forfait journalier a ete calcule a partir des donnees de comptabilite...
Douleur Et Analgesie, 2004
Résumé Les concepts de continuité et de globalité des soins sont reconnus aujourd’hui par tous c... more Résumé Les concepts de continuité et de globalité des soins sont reconnus aujourd’hui par tous comme inhérents à la médecine moderne. Un groupe de travail s’est réuni pour proposer des modèles de coordination des soins de support pour toutes les maladies graves dans les différents établissements de soins privés et publics. Les «soins de support» sont: «l’ensemble des soins et soutiens
The concept of continuous and global care is acknowledged today by all as inherent to modern medi... more The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor commu...
Bulletin de l'Académie Nationale de Médecine
Cancer/Radiothérapie
En médecine, en radiothérapie oncologique, comme ailleurs, le principe de qualité n'a de sens que... more En médecine, en radiothérapie oncologique, comme ailleurs, le principe de qualité n'a de sens que s'il est défini. En France comme partout, la radiothérapie a ses forces et ses faiblesses. Comme dans tous les pays, son avenir semble assuré par ses performances en termes de coût/efficacité comme par sa capacité à évoluer du triple point de vue de ses équipements, de ses métiers et de son organisation. Pourtant, la radiothérapie française est en crise. Les professionnels ont vu clair. Depuis plus de dix ans ils rappellent les autorités sanitaires à leurs responsabilités concernant les évolutions démographiques des radiothérapeutes et des physiciens, la rénovation des plateaux techniques, la modernisation des organisations, la promotion de l'évaluation des procédures et des résultats et le développement d'une plus grande équité dans les financements. Mais le retard pris, la mise sous pression des professionnels par l'État, ses services, ses agences et les médias à la suite des récents accidents, sont source de nombreux effets pervers et d'une grande inquiétude. L'accident d'Épinal a été l'initiateur d'un effort de professionnalisation de la gestion des risques, mais aussi d'une période troublée propice à une certaine confusion des esprits, au découragement et aux comportements protecteurs. Les risques ressentis par les professionnels semblent alors surtout provenir des autorités et des médias. Il apparaît que le thème de la qualité est au centre de tous les discours. Sous ce vocable, c'est en fait le respect des procédures liées à l'impératif de sécurité qui est privilégié par l'État et ses représentants. La sécurité apparente semble l'emporter sur la qualité réelle des pratiques. Le temps est donc venu d'une clarification des concepts de qualité et de sécurité, des organisations qui y concourent et de l'élaboration d'une stratégie claire rassemblant l'interprofession. Dans ce contexte, l'implication des sociétés savantes et en particulier de la Société française de radiothérapie oncologique est une nécessité.
Bulletin du cancer, 2004
The concept of continuous and global care is acknowledged today by all as inherent to modern medi... more The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor commu...
Oncomagazine, Aug 1, 2008
Bulletin Du Cancer, Jun 1, 2013
In the French health system, social security is the same for both public and private hospitals re... more In the French health system, social security is the same for both public and private hospitals regardless of their status. In terms of number of patients screened, diagnosed, or treated, independant medicine is the most important sector in the French oncology. The multitude of organizations representing private hospitals or independant oncologists, physicians, radiologists or pathologists have a common organization, the National Union for Private Hospital Oncology (UNHPC). It bases its action on two founding postulates to ensure the quality of the oncology practice : the medical and managerial cultures are complementary and should be articulated ; the quality of organizations is as important as professional competence.
Cancer/Radiothérapie
In medicine, as in oncological radiotherapy, as elsewhere, the precept of quality has no meaning ... more In medicine, as in oncological radiotherapy, as elsewhere, the precept of quality has no meaning if it is not defined. In France as everywhere radiotherapy has its forces and its weaknesses. As in every country, its future seems assured by its character cost effective as by its capacity to make progress in the triple point of view of its equipment, its professions and its organization. However, the French radiotherapy is in crisis. The professionals saw clearly. For more than 10 years they had recalled the medical authorities to their responsibilities concerning the demographic trends for the radiotherapists and the physicists, the renovation of the equipment, the modernization of the organizations, the promotion of the evaluation of procedures and outcomes and the development of a greater fairness in the financings. But the delay taken, the setting under pressure of the professionals by the State, its services, its agencies and the media following the recent accidents cause numerous perverse effects and worried the staff. The accident of Epinal was the starting fact of an effort of professionalisation of the risk management, but also of a disturbed period favourable with a certain confusion of minds, discouragement and protective behaviors. The risks felt by the professionals then seem especially to come from the authorities and the media. It appears that the topic of quality is at the center of all these speeches. Under this vocable, it is in fact the respect of the procedures related to the requirement of security which is privileged by the State and its representatives. The apparent security seems to override the real quality of the practices. Thus, time came for a clarification of the quality and security concepts, of organizations which contribute to it and for the development of a clear strategy bringing together the interprofessionnal actors. In this context, the implication of the College and especially of the Société française de radiothérapie oncologique is a requirement.
Annales Françaises d Anesthésie et de Réanimation