Du curatif au palliatif. Confrontation et renouvellement des pratiques hospitalières face à la fin de vie

Sur la base de données ethnographiques rendant compte d'échanges quotidiens entre une équipe mobile de soins palliatifs et différents services de « première ligne » d'un hôpital, cet article considère les relations d'intermédicalité entre ces cultures médicales divergentes. Dans un premier temps, les obstacles qui émergent lors de tentatives d'intégration du nouveau modèle proposé par les soins palliatifs seront discutés. En effet, celui-ci introduit une conception nouvelle de la trajectoire de la maladie incurable traduisant des valeurs fondamentales telles que prendre du temps et s'adapter aux besoins du patient tout en soulageant efficacement les symptômes liés à l'incurabilité et à la fin de vie. Les données recueillies dans cette enquête montrent que, tout en se confrontant à l'ordre hospitalier, les soins palliatifs participent dans une certaine mesure au renouvellement de pratiques institutionnelles. Dans un deuxième temps, ces confrontations et transformations seront lues à la lumière d'enjeux de pouvoir sous-jacents influençant le processus de reconnaissance des soins palliatifs dans le champ médical. En tant que nouvelle spécialité « à contre-courant », une forte adaptation est requise laissant poindre le risque d'assimilation de l'équipe mobile à l'institution hospitalière.

Visualizing key authenticity: turning your face into your public key

La informació biomètrica s'ha convertit en una tecnologia complementària a la criptografia que permet administrar còmodament les dades criptogràfiques. Són útils dues necessitats importants: en primer lloc, posar aquestes dades sempre a mà i, a més, fent fàcilment identificable el seu legítim propietari. En aquest article es proposa un sistema que integra la signatura biomètrica de reconeixement facial amb un esquema de signatura basat en la identitat, de manera que la cara de l'usuari esdevé la seva clau pública i la ID del sistema. D'aquesta manera, altres usuaris poden verificar els missatges utilitzant fotos del remitent, proporcionant un intercanvi raonable entre la seguretat del sistema i la usabilitat, així com una manera molt més senzilla d'autenticar claus públiques i processos de distribució.

Résistances tacites face à la requalification d'un quartier urbain en voie de gentrification : Regard à partir du quartier Le Maupas, Lausanne.

Quand un vent de changement souffle sur une ville, comment les quartiers qui la composent résistent-ils ? Le Maupas, une portion de la ville de Lausanne, présente les signes précurseurs d'un quartier en voie de gentrification. L'adoption dans cette recherche d'une approche praxéologique des espaces publics urbains implique une définition de ce phénomène, capable de rendre compte de ses caractéristiques dynamique et processuelle. Il s'agit d'étudier l'impact des aménagements urbains et de leurs usages. Je propose ici de recourir à des éléments en rapport avec la culture, la mobilité et la convivialité, afin de fournir un éclairage sur les tendances que peut prendre le quartier du Maupas. Ces tendances ne s'accomplissent pas sans quelques résistances explicites et tacites capables de contrecarrer, ou du moins ralentir la reclassification en cours. « Le Maupas » is part of the city of Lausanne. Because of some precursory signs, this neighbourhood is considered to be in the process of gentrification. This article deals with a praxeologic approach. It involves a dynamic conception of the urban public spaces and of gentrification. Studying the culture, the mobility and the conviviality features of « le Maupas », I try to highlight how social uses of urban settings manage resistance to change.

L'hypnose intégrée aux soins de patients brûlés: impact sur le niveau de stress de l'equipe soignante [Hypnosis integrated in burn care: impact on the healthcare team's stress].

Hypnosis for burn care was introduced in 2004 in the CHUV burn center showing great benefit for burned patients. Whereas advantages of hypnosis for the patient are well established, the impact on the medical staff remains poorly assessed. This manuscrit reviews current attested benefits of hypnosis for patients, specially for burned patients. The results of a recent study assessing the impact of hypnosis on the staffs level of stress caused by burn treatment, will also be introduced.

Team Effectiveness in Patient Health Management: An Overview of Reviews

Background: The desire to improve the quality of health care for an aging population with multiple chronic diseases is fostering a rapid growth in inter-professional team care, supported by health professionals, governments, businesses and public institutions. However, the weight of evidence measuring the impact of team care on patient and health system outcomes has not, heretofore, been clear. To address this deficiency, we evaluated published evidence for the clinical effectiveness of team care within a chronic disease management context in a systematic overview. Methods: A search strategy was built for Medline using medical subject headings and other relevant keywords. After testing for perform- ance, the search strategy was adapted to other databases (Cinhal, Cochrane, Embase, PsychInfo) using their specific descriptors. The searches were limited to reviews published between 1996 and 2011, in English and French languages. The results were analyzed by the number of studies favouring team intervention, based on the direction of effect and statistical significance for all reported outcomes. Results: Sixteen systematic and 7 narrative reviews were included. Diseases most frequently targeted were depression, followed by heart failure, diabetes and mental disorders. Effective- ness outcome measures most commonly used were clinical endpoints, resource utilization (e.g., emergency room visits, hospital admissions), costs, quality of life and medication adherence. Briefly, while improved clinical and resource utilization endpoints were commonly reported as positive outcomes, mixed directional results were often found among costs, medication adherence, mortality and patient satisfaction outcomes. Conclusions: We conclude that, although suggestive of some specific benefits, the overall weight of evidence for team care efficacy remains equivocal. Further studies that examine the causal interactions between multidisciplinary team care and clinical and economic outcomes of disease management are needed to more accurately assess its net program efficacy and population effectiveness.

The last days of dying stroke patients referred to a palliative care consult team in an acute hospital.

BACKGROUND AND PURPOSE: Needs of patients dying from stroke are poorly investigated. We aim to assess symptoms of these patients referred to a palliative care consult team, and to review their treatment strategies. METHODS: All charts of patients dying from stroke in a tertiary hospital, and referred consecutively to a palliative care consultant team from 2000 to 2005, were reviewed retrospectively. Symptoms, ability to communicate, treatments, circumstances and causes of death were collected. RESULTS: Forty-two patients were identified. Median NIH Stroke Scale on admission was 21. The most prevalent symptoms were dyspnoea (81%), and pain (69%). Difficulties or inability to communicate because of aphasia or altered level of consciousness were present in 93% of patients. Pharmacological respiratory treatments consisted of anti-muscarinic drugs (52%), and opioids (33%). Pain was mainly treated by opioids (69%). During the last 48 h of life, 81% of patients were free of pain and 48% of respiratory distress. The main causes of death were neurological complications in 38% of patients, multiple medical complications in 36%, and specific medical causes in 26%. CONCLUSIONS: Patients dying from stroke and referred to a palliative care consult team have multiple symptoms, mainly dyspnoea and pain. Studies are warranted to develop specific symptoms assessment tools in non-verbal stroke patients, to accurately assess patients' needs, and to measure effectiveness of palliative treatments.

Diversity management and team leadership in a nonprofit organization. Case: AIESEC in Finland

Tutkimuksen tarkoituksena on selvittää kuinka moninaisuus ja sen johtaminen näkyvät voittoa tavoittelemattoman järjestön tiimityössä, kuinka moninaisuus ja tiimityö pystyvät selittämään motiiveja työskennellä voittoa tavoittelemattomassa järjestössä ja mitä tulisi huomioida tiimityön ja tiimin johtajuuden osalta, kun moninaisuus ja voittoa tavoittelemattoman järjestön luonne otetaan huomioon. Tämä tutkielma on laadullinen tutkimus, jossa tutkimusmenetelminä on käytetty yhdeksää teemahaastattelua, edellisen tutkimuksen tuloksia (Astikainen, 2005) sekä havainnointia. Tutkimuksen perusteellavoidaan todeta, että voittoa tavoittelemattoman järjestön luonne, tiimityö tai moninaisuus eivät sinällään merkitse paljoakaan tulosten kannalta, vaan niiden keskinäiset yhteydet. Nämä yhdessä, oikein hyödynnettynä, vaikuttavat työntekijöiden motivaatioon ja sitä kautta organisaation tuloksiin.

Cardiorespiratory and Cardiac Autonomic Responses to 30-15 Intermittent Fitness Test in Team Sport Players

Buchheit, M, Al Haddad, H, Millet GP, Lepretre, PM, Newton, M, and Ahmaidi, S. Cardiorespiratory and cardiac autonomic responses to 30-15 Intermittent Fitness Test in team sport players. J Strength Cond Res 23(1): xxx-xxx, 2009-The 30-15 Intermittent Fitness Test (30-15IFT) is an attractive alternative to classic continuous incremental field tests for defining a reference velocity for interval training prescription in team sport athletes. The aim of the present study was to compare cardiorespiratory and autonomic responses to 30-15IFT with those observed during a standard continuous test (CT). In 20 team sport players (20.9 +/- 2.2 years), cardiopulmonary parameters were measured during exercise and for 10 minutes after both tests. Final running velocity, peak lactate ([La]peak), and rating of perceived exertion (RPE) were also measured. Parasympathetic function was assessed during the postexercise recovery phase via heart rate (HR) recovery time constant (HRRtau) and HR variability (HRV) vagal-related indices. At exhaustion, no difference was observed in peak oxygen uptake (&OV0312;o2peak), respiratory exchange ratio, HR, or RPE between 30-15IFT and CT. In contrast, 30-15IFT led to significantly higher minute ventilation, [La]peak, and final velocity than CT (p < 0.05 for all parameters). All maximal cardiorespiratory variables observed during both tests were moderately to well correlated (e.g., r = 0.76, p = 0.001 for &OV0312;o2peak). Regarding ventilatory thresholds (VThs), all cardiorespiratory measurements were similar and well correlated between the 2 tests. Parasympathetic function was lower after 30-15IFT than after CT, as indicated by significantly longer HHRtau (81.9 +/- 18.2 vs. 60.5 +/- 19.5 for 30-15IFT and CT, respectively, p < 0.001) and lower HRV vagal-related indices (i.e., the root mean square of successive R-R intervals differences [rMSSD]: 4.1 +/- 2.4 and 7.0 +/- 4.9 milliseconds, p < 0.05). In conclusion, the 30-15IFT is accurate for assessing VThs and &OV0312;o2peak, but it alters postexercise parasympathetic function more than a continuous incremental protocol.