Medical students' learning processes the first time they role-play in psychiatry: A grounded theory study.

BACKGROUND: Recent changes in psychiatric care and teaching that limit patient contact for medical students can be overcome in part by simulation-based education. Understanding the learning processes of medical students involved in psychiatric simulation-based programmes could usefully inform efforts to improve this teaching. This study explored the learning processes of medical students the first time they role-play in psychiatry. METHODS: We used constructivist grounded theory to analyse semi-structured interviews of 13 purposively sampled medical students and the six psychiatrists who trained them. To improve the triangulation process, the results of this analysis were compared with those of the analyses of the role-play video and the debriefing audio-tapes. RESULTS: Five organising themes emerged: improving the students' immediate perception of patients with mental disorders; cultivating clinical reasoning; managing affect; enhancing skills and attitudes and fostering involvement in learning psychiatry. CONCLUSION: Results suggest that psychiatric role-playing can improve students' progressive understanding of psychiatry through the development of intuition and by allaying affects. Emotional elaboration and student involvement appear to be key features.

[Acute and chronic toxicities associated with the use and misuse of nitrous oxide: An update]. / Toxicités aiguës et chroniques associées à l'usage et au mésusage du protoxyde d'azote : mise au point.

Nitrous oxide (N2O) is used since the eighteenth century as an anesthetic and analgesic but also for recreational use. If the labelled uses of N2O and their modalities are nowadays perfectly framed, the misuse of N2O takes very alarming proportions among teenagers and young adults. This misuse is the cause of acute (hypoxia, barotrauma, burns, neuropsychiatric disorders) and chronic complications if repeated (myeloneuropathy, anemia, thrombosis, inhalant use disorder). The main mechanism of the latter is mainly related to a functional deficit in vitamin B12 induced by N2O. The management of acute complications is symptomatic. The management of chronic complications is based on vitamin B12 supplementation. The best biomarker of chronic N2O exposure is the elevation of the plasmatic level of methylmalonic acid. In all cases of recreational misuses, addiction treatment is necessary to prevent complications or their worsening by providing information in order to stop consumption.

["Somatic symptom disorders" in adolescence. A systematic review of the recent literature]. / « Troubles à symptomatologie somatique ¼ chez les adolescents. Une revue systématique.

OBJECTIVES: Body expression of mental disorders is common in adolescence. Only two literature reviews over the last five years have been identified about somatoform disorders in children., The present article provides a systematic review of articles in English, which concern "Somatic Symptom and Related Disorders" according to the DSM-5 (Diagnostic and Statistical Manual - 5th Edition) among adolescents. METHODS: The article search was made on Medline, Psychinfo, Google Scholar, BiomedCentral, Central and tripdatabase (for grey literature) according to PRISMA criteria and with the items "somatoform disorders" or "somatic symptom disorders". An age filter was applied for "adolescents", and a selection was done from the last five years. All articles concerning adolescents (often associated with children) were initially included, except for articles concerning eating disorders, dysmorphic disorders or adult population. Comments, editorials, opinion or descriptive articles were also excluded. The authors then carried out an analysis of the main topics, themes and questions covered in the selected publications and presented a descriptive synthesis. RESULTS: A total of seventy-seven publications were included in the analysis, from three hundred and seventy-two publications. First, the terms used to refer to these "somatic symptom disorders" were varied, such as "somatization", "somatic complaints/symptoms", "functional disorder", "unexplained symptoms" and "somatoform disorders". Then, studies related just to adolescents were limited: most of studies included children and adolescents in their methodologies; and some of them questioned somatic symptoms from a developmental perspective. Case reports were the most represented articles among all medical specialties, with clinical descriptions about "functional neurological symptom disorder", "factitious disorder" and "somatic symptom disorder" with a medical disease, among children and adolescents. We sometimes observed a controversial borderline between psychological and somatic disorders. Various explanatory models appeared, especially the trauma path; familial and social environment was also pointed out, with a possible peer group effect; neurocognitive theories were finally described. The literature highlights the effectiveness of psychosocial therapies (especially the cognitive-behavioral therapy) and the importance of multidisciplinary management. Finally, a few studies with a qualitative methodology are represented. CONCLUSIONS: Only nine articles included "somatic symptom disorder" in their titles, despite a terminology valued by many authors (compared to "somatoform disorders" from the DSM-IV). The heterogeneity of terminologies, case reports and explanatory models witness a lack of connexions between medical specialties. This could explain in part the wandering of adolescents and their families in the health care system. It could also contribute to the delay before diagnosis, especially when neurological symptoms exist, and a late referral for psychiatric consultation. Further studies are needed to understand difficulties to use a clinical pathway among medical specialties, when the benefit of amultidisciplinary approach seems to be unanimous.

[Health planning and management, instruments for technical cooperation]. / Planification et gestion sanitaires, instruments de coopération technique.

Western models of health strategy are not applicable in developing countries. These need, for developing original and effective health services and systems, a planning method meeting their specific requirements. A WHO-sponsored collaborative development effort from 1970 to this day resulted in a set of programming, project formulation and management procedures broadly based on the systems approach. The 31st World Health Assembly commended this effort, which is on-going.

Use of an epidemiological model for estimating the effectiveness of tuberculosis control measures. Sensitivity of the effectiveness of tuberculosis control measures to the social time preference.

Different combinations of coverage levels of BCG vaccination and of case-finding and treatment may achieve the same problem reduction in epidemiological terms. But the same problem reduction, in man-years of tuberculosis, may be valued differently in social terms.A social-time-preference parameter, of the form 1/(1+r)(t), is relevant to this evaluation and the level of r is critical for policy decision. The present paper studies the sensitivity of the effectiveness of BCG vaccination and of case-finding and treatment to the level of r, and the epidemiological mechanism underlying such sensitivity. A high value of r can be visualized as corresponding to a close planning horizon, a lower value of r to a more distant one. At any level of epidemiological effectiveness, a planner with a high value of r would favour case-finding and treatment, and a planner with a low value of r would tend to emphasize BCG vaccination. This influence of the social-time-preference parameter on the planner's decision is found to depend on the discounting effect of the parameter on the one hand, and on the different age- and time-patterns of the preventive effect of the major control measures, on the other.

The use of an epidemiological model for estimating the effectiveness of tuberculosis control measures. Sensitivity of the effectiveness of tuberculosis control measures to the coverage of the population.

Given an adequate definition of the disease problem in epidemiological terms, it is possible to measure the epidemiological effectiveness of control measures in terms of problem reduction. This is to be distinguished from the clinical efficacy of the same measures. The practical difficulty in assessing the epidemiological effectiveness of control measures experimentally can be overcome by the construction of simulation models and the use of computers, whereby the problem reduction associated with various control strategies can be estimated numerically.By varying the levels of certain parameters of the model systematically, the sensitivity of the effectiveness of control measures to the epidemiological, operational, clinical and social parameters of a situation can be assessed. A series of articles analysing this relationship is under preparation. This first article analyses the sensitivity of the effectiveness of BCG vaccination and of the chemotherapy of tuberculosis to changes in the coverage of the eligible population groups. A previously formulated postulate stating that the marginal effectiveness of these measures decreases as their coverage increases is validated by this first series of simulations. The significance of this finding for planning national tuberculosis control strategies is discussed, as well as possible bias in the method applied.