Admission criteria and management of critical care patients in a pandemic context: position of the Ethics Commission of the French Intensive Care Society, update of April 2021.

Intensive care unit professionals have experience in critical care and its proportionality, collegial decision-making, withholding or withdrawal of treatment deemed futile, and communication with patients' relatives. These elements rely on ethical values from which we must not deviate in a pandemic situation. The recommendations made by the Ethics Commission of the French Intensive Care Society reflect an approach of responsibility and solidarity towards our citizens regarding the potential impact of a pandemic on critical care resources in France, with the fundamental requirement of respect for human dignity and equal access to health care for all.

Self-medication in pain management: The state of the art of pharmacists' role for optimal Over-The-Counter analgesic use.

BACKGROUND AND OBJECTIVE: Self-medication is associated with an important utilization of Over-The-Counter (OTC) analgesics. The medical outcome resulting from therapeutic options bypassing the physician prescription is a major issue. In that context, pharmacists are expected to play a crucial role. The main objective of this review was to analyse the state-of-the art of pharmacists' role in pain management self-medication. DATABASES AND DATA TREATMENT: An expert multidisciplinary group dedicated to self-medication in pain was established. Selection of publications was performed from PubMedand EMBASE databases which was based on the use of "pain" and/or "self-medication" and/or "self-care" and/or "analgesics" and/or "painkillers" keywords, restricted to the past 10 years. RESULTS: A total of 480 papers were identified, 49 of which papers were considered relevant and finally kept for final discussion, on OTC pain management and pharmacist's role. Literature analysis demonstrates that OTC analgesics are generally safe when appropriately used. Risks associated with misuse or inappropriateness depend on patients' vulnerability (elderly, pregnancy) or behaviour. Social cognitive theory-based intervention and multimedia applications improve self-medication but do not replace health care professional advice Pharmacists' interventions may improve the benefits and safety of OTC analgesic medication, with a better management of pain. CONCLUSIONS: Considering the heterogeneity of patients' knowledge and behaviour reported worldwide, inappropriate use of OTC pain medication should not be underestimated. Community pharmacists are ideally placed to guide self-medication or recommend a medical advice when needed. Embedding pharmacists in primary care pain management is essential and pharmacist-led medication coupled with an appropriate training of pharmacy staffs should be encouraged. SIGNIFICANCE: Analgesics are widely used without prescription, all over the world. They represent the largest market of OTC drugs, with an overall benefit/risk ratio favourable when appropriately used. Because of potential individual risks associated to the ailment or to the patient's behaviour, pharmacists' interventions have proven to optimize analgesic self-medication, provided that pharmacy staffs are both available and more specifically trained. In the future, in pain management, especially self-medication, pharmacists should play an increasing role and should be included in educational programmes and pain management guidelines.

[Dignity and the elderly: age makes no difference]. / Dignité et personne âgée: l'âge ne fait rien a l'affaire.

Elderly people are human beings, dependent maybe, but still with a right to their dignity. However, in an institute, it is difficult to carry out care and monitor the residents at the same time as ensuring they have space for privacy and freedom. Overprotection and the sacralisation of autonomy can slide towards mistreatment. We must ensure that we are not submerged by the prevailing ideology which would have us believe that a dependent elderly person is a burden on society and that the solution to suffering is death.

[The physiological and cultural roots of pain]. / Aux racines physiologiques et culturelles de la douleur.

The treatment of pain is a major issue. However, it is not always possible for nurses to relieve patients or to understand the social, cultural and psychological roots of the pain. Pain is, by definition, felt on an individual level while at the same time being a concept which can be generalised and which is an inherent part of humanity. Understanding this constitutes a way of treating pain.

[Understanding disability, a first act of care]. / Penser le handicap, un premier acte de soin.

One of the ways of taking care of another person consists in banishing prejudices. With disabled patients, nurses must avoid empathy which would lead them to consider the disability from their personal point of view. Disability obliges caregivers to move away from their usual understanding of the body, sensations, perceptions and imagination. Rather than putting oneself in the place of the disabled person it is a question of understanding the difference.

[Considering all facets of man]. / Penser l'homme selon toutes ses facettes.

Michel Foucault and Erving Goffman, through their works, questioned the notion of mental illness as well as traditional psychiatry. However, Friedrich Hegel, in reference to Philippe Pinel and to "human treatment" is opposed to any unilateral model which would tend to exclude the institution, insanity and therefore the patient.

[Imprisonment, stigmatisation and society]. / Enfermement, stigmatisation et société.

Philosophic reflection suggests that every human being is different and that the difference is apparent in the light of other people. Thinking about the destigmatisation of psychically disabled persons requires understanding that identity is not an objective reality. Self-esteem, mirror, difference or resemblance, so many terms which remind us that we are imperfect....