[Hypnoanalgesia, a complementary therapy for painful care procedures]. / L'hypno-analgésie, une offre complémentaire pour les soins douloureux.

In the framework of the management of patients receiving hyperbaric oxygen therapy, hypnoanalgesia is a complementary pain management tool, notably during the changing of dressings. Trained in this management of care-related pain, the teams of the hypebaric medicine centre in Lyon share their experience.

[Pain, from symptom to syndrome]. / La douleur, du symptôme au syndrome.

Acute pain is a symptom enabling us to implement a response when faced with an attack. Chronic pain is complex and multifactorial. The care of the patient by a multidisciplinary team comprises the diagnosis of the pain and the putting in place of a treatment for each of its components. This includes physical reconditioning, adaptation strategies and work on the psychological elements relating to the representation of the pain.

[Hypnoanalgesia and clinical nursing reasoning]. / Hypnoanalgésie et raisonnement clinique infirmier.

Hypnoanalgesia is practised in accordance with care ethics and as a complement to other medical and/or psychological therapies. It is aimed at people with acute, chronic or treatment-related pain. Its practice is founded on clinical nursing reasoning, which targets the health problem and the therapeutic objectives guiding the hypnosis session. A clinical assessment finalises the interactional process.

[The non-pharmacological management of chronic pain]. / La prise en charge non médicamenteuse de la douleur chronique.

Pain management is not limited to the putting in place of pharmacological, surgical, physiotherapy or psychological strategies. Non-pharmacological therapies can also be proposed, notably in relation to chronic pain. Appreciated by patients and developed by caregivers, they require appropriate regulatory guidelines and specific training in order for them to be implemented safely.

[The pain resource nurse consultation guidelines]. / Le référentiel de consultation de l'infirmière ressource douleur.

The cross-disciplinary activities of pain resource nurses were provided with guidelines in 2007. Due to the development of their role in care structures and the ongoing organisation of the nursing activity, guidelines relating to their consultation activities were drawn up in 2016. These describe the circumstances in which a pain resource nurse may intervene and the types of consultation she carries out.

[The coordination of community care for patients with chronic pain]. / La coordination des soins de ville aux patients souffrant de douleurs chroniques.

Patients with chronic pain require global and multi-disciplinary care. The network "Lutter contre la douleur" offers coordinated support for health professionals and a multidimensional assessment of the patients. Its therapeutic education programme favours learning of bodymind techniques. In this context, the nurse coordinator can play a key role in ensuring the efficiency of the patient management and health care pathway.

[Territorial resources and access to care in the case of chronic pain]. / Ressources territoriales et accès aux soins en cas de douleur chronique.

To respond to the complexity of the management of patients with chronic pain, an adapted and structured biopsychosocial approach is necessary. Created and managed by committed caregivers, regulated and financed by decision-making bodies, chronic pain assessment and treatment centres form part of the patient care pathway.

Video consultations as add-on to standard care among patients with type 2 diabetes not responding to standard regimens: a randomized controlled trial.

OBJECTIVE: To examine whether video consultations preceded by measurements of blood glucose, weight and blood pressure as add-on to standard care could contribute to achieving and maintaining good diabetes control among patients with poorly regulated type 2 diabetes (T2D). DESIGN: Randomized controlled trial. METHODS: 165 patients with T2D were randomized 1:1 to telemedicine intervention as add-on to clinic-based care or control (clinic-based care). The intervention consisted of monthly video conferences with a nurse via a tablet computer and lasted for 32 weeks. Regularly self-monitored measurements of blood sugar, blood pressure and weight were uploaded and visible to patient and nurse. Both groups were followed up six months after the end of the intervention period. PRIMARY ENDPOINT: HbA1c after eight months. RESULTS: Video conferences preceded by uploads of measurements as add-on to clinic-based care led to a significant reduction of HbA1c compared to that in standard care (0.69% vs 0.18%, P = 0.022). However, at six-month follow-up, the inter-group difference in HbA1c-reduction was no longer significant. Non-completers had higher HbA1c levels at baseline and a lower degree of education. CONCLUSION: Video consultations preceded by uploading relevant measurements can lead to clinically and statistically significant improvements in glycemic control among patients who have not responded to standard regimens. However, continuing effort and attention are essential as the effect does not persist when intervention ends. Furthermore, future studies should focus on differentiation as the most vulnerable patients are at greater risk of non-adherence.

[Glioblastoma in 2017]. / Les glioblastomes en 2017.

Glioblastomas are serious tumours of the central nervous system. Recurrence is systematic and prognosis poor. Radiotherapy and chemotherapy follow surgery, when surgery is possible, to lengthen survival, while preserving quality of life as much as possible. In this respect, symptomatic treatments and supportive care are necessary.

A multicentre demonstration project to evaluate the effectiveness and acceptability of the web-based Joint Asia Diabetes Evaluation (JADE) programme with or without nurse support in Chinese patients with Type 2 diabetes.

AIMS: To test the hypothesis that delivery of integrated care augmented by a web-based disease management programme and nurse coordinator would improve treatment target attainment and health-related behaviour. METHODS: The web-based Joint Asia Diabetes Evaluation (JADE) and Diabetes Monitoring Database (DIAMOND) portals contain identical built-in protocols to integrate structured assessment, risk stratification, personalized reporting and decision support. The JADE portal contains an additional module to facilitate structured follow-up visits. Between January 2009 and September 2010, 3586 Chinese patients with Type 2 diabetes from six sites in China were randomized to DIAMOND (n = 1728) or JADE, plus nurse-coordinated follow-up visits (n = 1858) with comprehensive assessments at baseline and 12 months. The primary outcome was proportion of patients achieving ≥ 2 treatment targets (HbA1c < 53 mmol/mol (7%), blood pressure < 130/80 mmHg and LDL cholesterol < 2.6 mmol/l). RESULTS: Of 3586 participants enrolled (mean age 57 years, 54% men, median disease duration 5 years), 2559 returned for repeat assessment after a median (interquartile range) follow-up of 12.5 (4.6) months. The proportion of participants attaining ≥ 2 treatment targets increased in both groups (JADE 40.6 to 50.0%; DIAMOND 38.2 to 50.8%) and there were similar absolute reductions in HbA1c [DIAMOND -8 mmol/mol vs JADE -7 mmol/mol (-0.69 vs -0.62%)] and LDL cholesterol (DIAMOND -0.32 mmol/l vs JADE -0.28 mmol/l), with no between-group difference. The JADE group was more likely to self-monitor blood glucose (50.5 vs 44.2%; P = 0.005) and had fewer defaulters (25.6 vs 32.0%; P < 0.001). CONCLUSIONS: Integrated care augmented by information technology improved cardiometabolic control, with additional nurse contacts reducing the default rate and enhancing self-care. (Clinical trials registry no.: NCT01274364).

Home-based vs inpatient education for children newly diagnosed with type 1 diabetes.

BACKGROUND: Initial management of children diagnosed with type 1 diabetes (T1D) varies worldwide with sparse high quality evidence regarding the impact of different models of care. AIM: To compare the inpatient model of care with a hybrid home-based alternative, examining metabolic and psychosocial outcomes, diabetes knowledge, length of stay, and patient satisfaction. SUBJECTS AND METHODS: The study design was a randomized-controlled trial. Inclusion criteria were: newly diagnosed T1D, aged 3 to 16 years, living within approximately 1 hour of the hospital, English-speaking, access to transport, absence of significant medical or psychosocial comorbidity. Patients were randomized to standard care with a 5 to 6 day initial inpatient stay or discharge after 2 days for home-based management. All patients received practical skills training in the first 48 hours. The intervention group was visited twice/day by a nurse for 2 days to assist with injections, then a multi-disciplinary team made 3 home visits over 2 weeks to complete education. Patients were followed up for 12 months. Clinical outcomes included HbA1c, hypoglycemia, and diabetes-related readmissions. Surveys measured patient satisfaction, diabetes knowledge, family impact, and quality of life. RESULTS: Fifty patients were recruited, 25 to each group. There were no differences in medical or psychosocial outcomes or diabetes knowledge. Average length of admission was 1.9 days shorter for the intervention group. Families indicated that with hindsight, most would choose home- over hospital-based management. CONCLUSIONS: With adequate support, children newly diagnosed with T1D can be safely managed at home following practical skills training.

[Anorexia and borderline personality disorder : bonds pathology]. / Anorexie mentale et trouble borderline : une pathologie du lien.

Comorbidity with a borderline personality disorder is far from rare in patients suffering from eating disorders. Clinically, this presents as chronic instability in many areas: interpersonal relationships, self-image, emotions, mood and acting out. Treatment is mainly based on a containing and reassuring therapeutic framework. A care plan may be put in place that incorporates reducing impulsive harmful, eating and self-harming behaviours. Dialectical behaviour therapy is intended in particular to prevent suicide risk in borderline personality disorder patients.

[My stomach, the monster under my bed]. / Mon ventre, ce monstre caché sous mon lit.

Care for patients with eating disorders is complex and plurimodal. Care plans need to be adapted in order to take into account the body in crisis. A series of hospital admissions combined with specific psychomotor approaches, can contribute to the patient being reappropriated with their own body.

[Relaxation, a complementary approach for mental health nurses]. / La relaxation, une approche complémentaire pour l'infirmier en santé mentale.

Relaxation is arousing growing interest in mental health. Its positive effects are in line with an active approach which brings together body and mind and place the individual back on the path of self-awareness. The relationship with the patient constitutes the "therapeutic we" ensuring its therapeutic importance. It represents a complementary and original approach to caring.

[Beyond suffering, schizophrenic improvisation and therapeutic challenges]. / Au-delà des maux, improvisation schizophrénique et (en)jeux thérapeutiques.

Led jointly by an actress and an occupational therapist, an 'improvisation' activity has been set up within the Sainte-Anne University Hospital SHU Sector 14 for hospitalised patients, on medical prescription. This containing environment provides psychological support and encourages patients with schizophrenia to explore their creativity and to 'let go' so as to discover new physical possibilities. The group thereby becomes a support for the relationship and the development of verbal and non-verbal communication.