[Physicians and patients faced with chronic illness]. / Médecins et patient-e-s face à la maladie chronique.

Chronic illness represents a real challenge in terms of overall patient care, but also an opportunity for a different kind of encounter with the patient. Moving away from the paradigm of acute disease, the medical therapeutic approach to chronic illness can be revisited with the aim of both improving the way we listen to the patient and his or her history, and maintaining a lively clinical interest in the face of disorders that are often difficult to treat over the long term. Taking an interest in patients' representations enables us to gain a finer understanding of their clinical situations, while at the same time allowing for more individualized care. Finally, the question of acceptance of illness in the broadest sense, and of a chronic disorder in particular, is a subject that should be discussed with patients.

La maladie chronique représente un véritable défien termes de prise en charge globale du patient, mais également l'opportunité d'une rencontre différente avec le-la patient-e. S'éloignant du paradigme de l'atteinte aiguë, l'approche thérapeutique médicale des maladies chroniques peut être revisitée dans le but, d'une part, d'améliorer notre manière d'écouter le patient et son histoire et, d'autre part, de conserver un intérêt clinique vivant face à des troubles souvent difficiles à soigner dans la durée. S'intéresser aux représentations des patient-e-s permet une compréhension plus fine des tableaux cliniques, tout en permettant une prise en charge plus individualisée. Enfin, la question de l'acceptation de la maladie au sens large, mais d'un trouble chronique en particulier, est un sujet qu'il importe de pouvoir aborder avec les patient-e-s.

[Relevance of interventions and support for relatives of an individual who made a suicide attempt]. / Importance de l'accompagnement des proches confrontés à une tentative de suicide.

Suicide and suicide attempt has an impact not only on the suicidal individual but also on his relatives. People expose to suicidal behavior of a close relation are confronted to death or to death threat and are subject to various signs such as anxiety, depression, specially linked to trauma. Therefore, it is essential to support those relatives in their suffering. Three types of intervention are distinguished according to timing: immediate, post-immediate and mid-to-long term interventions.

Le suicide avéré et la tentative de suicide ont un impact important sur la personne suicidaire mais aussi sur ses proches. Ces derniers se voient confrontés à la mort ou à une menace de mort, ce qui peut entraîner la survenue d'une panoplie de syndromes dépressifs et anxieux, surtout liés au traumatisme. Il est essentiel d'intervenir auprès des proches pour accompagner la souffrance psychique souvent présentée. Les interventions proposées sont subdivisées en trois temps distincts : interventions immédiates, postimmédiates et à moyen, voire à long terme.

["White code protocol": model of interprofessional collaboration in the emergency room]. / « Code blanc ¼ : modèle de collaboration interprofessionnelle aux urgences.

Acute agitation is a frequent cause of emergency department's consultation. Managing an agitated patient is complex due to many factors and require from healthcare teams a close interdisciplinary collaboration. Scope of this article is to describe the management of agitated patients in an emergency department and to present an interprofessional medical care protocol (white code protocol), giving also the opinion of principal actors of this healthcare interdisciplinary model.

L'agitation psychomotrice aiguë est fréquente dans les services d'urgences. La prise en charge d'un patient agité s'avère complexe en raison de multiples facteurs et nécessite de la part des intervenants une collaboration interdisciplinaire étroite. Cet article a pour but de synthétiser les principes de prise en charge d'une agitation aiguë dans un service d'urgences et de détailler un protocole interprofessionnel de prise en charge (code blanc), en présentant l'opinion des principaux intervenants de ce modèle interprofessionnel de soins.

Patients with first versus multiple episodes of self-harm: how do their profiles differ?

BACKGROUND: Self-harm (SH) is among the strongest predictors of further episodes of SH, suicide attempt, and death by suicide. People who repeteadly harm themselves are at even higher risk for suicide. Factors influencing the repetition are important to identify when assessing suicidal risk and thereafter to offer specific interventions. Therefore, this study aimed to compare first versus multiple episodes characteristics in a large sample of patients in french-speaking Switzerland. METHOD: We used the database from the French-speaking Swiss program for monitoring SH. Data of the psychiatric assessment of all adults admitted for SH were collected in the emergency department of four Swiss city hospitals between December 2016 and October 2019. RESULTS: 1730 episodes of SH were included. Several variables were significantly associated with multiple episodes, including diagnosis (over representation of personality disorders and under representation of anxiety disorders), professional activity (Invalidity insurance more frequent) and prior psychiatry care. CONCLUSIONS: Patients suffering from a personality disorder and those with invalidity insurance are at risk for multiple episodes of SH and should be targeted with specific interventions.

[When hotlines remain cold: Psychological support in the time of pandemic]. / Quand le téléphone ne chauffe pas : les hotlines psy en situation de pandémie.

In Switzerland and elsewhere, many psychological support hotlines were set up during the acute phase of the COVID-19 pandemic. Specialists in psychological first aid, in charge of developing and managing these hotlines, had to face an unknown situation, very different from the disasters for which they prepare themselves. Since the pandemic and the associated physical distancing were a potential threat to social cohesion, one could make the hypothesis that, by setting up hotlines, these professionals sought to reintroduce a form of proximity and to care for and cultivate the social connections among people. The pressure, feelings of emergency, anxious anticipation and expectation of the political authorities and the population may have favoured the development of these structures. Other factors certainly also played a role, such as the need to be useful and to exist as professional, or the need to act in order to reduce anxiety related to the pandemic. Altogether, these hotlines were little used, and their usefulness may be questioned. Similar phenomena have been observed - especially in the sanitary domain - with a multiplication of new offers, not always adjusted to specific identified needs, while health care services were on the same time under-used. Our observations plead against emergency responses in crisis situations and for reflecting on the measures to be put in place rather than to "act" them.

[ASSIP: A new therapy following suicide attempt]. / ASSIP : nouvelle modalité thérapeutique après un geste suicidaire.

Although patients attempting suicide represent a highly vulnerable population, are often reluctant to care and at high risk of repetition, no specific therapy exist for them in French-speaking Switzerland. ASSIP® (Attempted Suicide Short Intervention Program) fills in this gap. It is a short therapy developed in Bern and being currently implemented in French-speaking Switzerland with the support of the Foundation « Promotion santé suisse ¼ (Swiss health care promotion). ASSIP® intervention is patient-centered and based on a narrative and behavioral approach and reduces suicide reattempts. It aims to jointly understand patient's suicidal process and to help him/her developing personal strategies to prevent repetition and manage future suicidal crisis.

En Suisse romande, les personnes ayant fait une tentative de suicide n'ont actuellement pas de prise en charge thérapeutique spécifique, alors qu'il s'agit d'une population particulièrement vulnérable, souvent réticente aux soins et présentant un risque élevé de récidive. Pour combler ce manque, une thérapie brève en quatre séances élaborée à Berne (l'Attempted Suicide Short Intervention Program (ASSIP)) est en cours d'implantation avec le soutien de la fondation Promotion santé suisse. Proposée en parallèle du traitement habituel, l'ASSIP est basée sur une approche narrative et cognitivocomportementale, centrée sur la personne. Efficace pour prévenir la récidive suicidaire, cette intervention vise à mieux comprendre le processus suicidaire et à permettre aux patients de développer des ressources afin de prévenir et d'agir lors d'une prochaine crise suicidaire.

[«â€ Group medical practices†¼ project†: collaboration between primary care medicine and institutional public psychiatry]. / Projet «â€ cabinets de groupe†¼â€ : collaboration entre médecine de premier recours et psychiatrie.

Collaboration between primary care medicine and psychiatry is a well-known challenge. In order to improve access to psychological care for patients undergoing primary care, the «â€…group medical practices ¼ project proposes a collaborative care model in which a psychiatrist employed by a public psychiatric institution integrates group medical practices in order to provide assistance to primary care physicians. It is thus able to evaluate patients directly in the practices and to offer supervision and consilium spaces to primary care physicians.

La collaboration entre la médecine de premier recours et la psychiatrie représente une difficulté bien connue. Pour améliorer l'accès aux soins psychiques des patients suivis en médecine de premier recours, le projet «â€…cabinets de groupe ¼ propose un modèle de soins collaboratifs dans lequel un psychiatre employé d'une institution psychiatrique publique intègre des cabinets de groupe afin d'apporter son aide aux médecins de premier recours (MPR). Il est ainsi en mesure, d'une part, d'évaluer les patients directement au sein des cabinets et, d'autre part, d'offrir des espaces de supervision et de consilium aux MPR.

[Meeting suicidal patient†: ongoing actions in French speaking Switzerland]. / Les enjeux de la rencontre avec la personne suicidaire - Apports du Groupe romand prévention suicide (GRPS).

This article describes a model designed by an ad hoc group in French-speaking Switzerland to help professionals meeting suicidal patients. Based on current scientific knowledge, it promotes the clinical encounter with patient rather than a quantitative risk assessment, which may interfere with therapeutic alliance. This model underlines the importance of a reflexive position from the caregiver, who should keep a critical view on his own practice and opinions on suicidal process.

Cet article décrit le modèle d'aide à la rencontre de la personne suicidaire et à l'évaluation du potentiel suicidaire développé par le Groupe Romand Prévention Suicide (GRPS). S'appuyant sur les connaissances scientifiques actuelles, il privilégie la rencontre clinique à l'évaluation, et se distancie des méthodes cherchant à prédire le suicide, qui peuvent entraver la rencontre. Ce modèle valorise un regard curieux de l'intervenant sur sa propre pratique et ses possibles préjugés en lien avec la problématique suicidaire.

Using patient-reported outcome measures to assess the effectiveness of social media networking programs for people living with overweight and obesity to adopt a healthier lifestyle.

Introduction: Overweight, obesity, and their associated health complications have become a major public health issue. Online approaches have been rarely attempted to address the problem. The aim of this study was to evaluate the effectiveness of using social media networking for people living with overweight and obesity to adopt a healthier lifestyle with a three-month multidisciplinary healthcare program. Effectiveness was assessed through questionnaires on patient-related outcome measures (PROMs). Materials and methods: Two non-profit associations designed the program delivered to people living with overweight and obesity in a closed group via Facebook, the popular social network. The three-month program had three main axes, namely nutrition, psychology, and physical activity. Anthropomorphic data and sociodemographic profiles were collected. Quality of life (QoL) was assessed at the beginning and at the end of the intervention using PROM questionnaires for six different domains, i.e., body image, eating behavior, physical, sexual, social, and psychological functioning. Results: Six hundred and twenty persons participated in the program; 567 persons consented for the study, and 145 completed the questionnaires entirely. QoL was significantly improved in five out of six domains, i.e., body image, eating behavior, as well as physical, sexual, and psychological functioning. The improvement was valid regardless of age, gender, initial body mass index, person with or without children, educational level (primary versus secondary versus high school), and occupation (employment compared to unemployment or any kind of social assistance). In multivariate analysis, living as a couple was an independent factor correlated to a positive progression in four domains, i.e., body image, eating behavior, as well as physical, and psychological functioning. Conclusion: This study showed that an online lifestyle intervention might be a promising way of improving the quality of life of people living with overweight or obesity.

Psychiatric consultation in general practitioners' daily practice: a qualitative study on the experience of consultation-liaison psychiatry interventions in primary care settings in French-speaking Switzerland.

BACKGROUND: Mental disorders are frequent in primary care settings, which is challenging for primary care physicians. In Neuchâtel (Switzerland), a Consultation-Liaison psychiatrist integrated three primary care group practices, proposing both clinical interventions and supervisions/psychiatric training. Primary care physicians' experience regarding this collaboration was investigated. METHODS: A qualitative study was conducted. Three focus groups were organized in each primary care group practice involved in the project (10 primary care physicians participated in focus groups). Data were analysed with thematic content analysis. RESULTS: Six major themes emerged from our analysis, describing primary care physicians' collaboration with psychiatrists: 1) Impact on a difficult to reach and "reluctant to consult" population; 2) Fluidity of the intraprofessional collaboration; 3) Influence on the doctor-patient relationship; 4) Positive emotional experiences; 5) Psychiatric counselling and training; 6) Long-term prospects for the project. CONCLUSIONS: Consultation-Liaison psychiatrist's presence came as a relief for participating primary care physicians, facilitating accessibility to mental healthcare, introducing a common culture of care, and offering "in-situ" psychiatric training. Primary care physicians felt that their relationships with patients benefited from such interventions, being better able to deal with complex emotional experiences and found patients more confident regarding proposed care. Models of psychiatric intervention provided in primary care must establish settings of collaboration that reinforce relationships between primary care physicians, psychiatrists, and patients.

Is an Early Resumption of a Regular Diet After Laparoscopic Roux-en-Y Gastric Bypass Safe?

BACKGROUND: Return to a normal diet is a crucial step after bariatric surgery. Proximal anastomosis is a source of concern for early feeding as the passage of solid food through a recent anastomosis could well increase pressure and the risk of leakage. This study aims to assess the safety of an early normal diet after a laparoscopic Roux-en-Y gastric bypass (LRYGB). MATERIALS AND METHODS: All consecutive patients undergoing primary LRYGB between January 2015 and December 2020 were included prospectively. Three postoperative pureed diets were compared at 4 weeks, 2 weeks, and 1 week. All-cause morbidity at 90 days was the main outcome. Overall complications, severe complications (Clavien-Dindo ≥ grade 3a), length of hospital stay, number of emergency, and unplanned consultations during the 3 postoperative months were recorded for each group. RESULTS: Three hundred and sixty-seven patients with a mean BMI of 42.10 kg/m2 (± SD: 4.78) were included. All-cause morbidity at 90 days was 11.7% (43/367) and no significant difference was observed between the 3 groups. Adjustment for patients and operative cofounders did not demonstrate any increased risk of postoperative complications between the 3 groups, with an odds ratio of 1, 1.23(95% CI [0. 55-2.75]), and 1.14 (95% CI [0.49, 2.67]) for groups 1, 2, and 3 respectively. Severe complications (Clavien-Dindo ≥ grade 3a) and emergency or unplanned consultations were also similar in the 3 groups. CONCLUSION: Return to a normal diet 1 week after LRYGB did not increase short-term morbidity and unplanned consultations. It may be safe and contribute to patient comfort.

When to discharge and when to voluntary or compulsory hospitalize? Factors associated with treatment decision after self-harm.

Clinicians assessing suicidal patients in emergency departments (EDs) must decide whether to admit the person to a psychiatric ward with voluntary or compulsory hospitalization or to discharge him/her as an outpatient. This cross-sectional study aimed to identify independent predictors of this decision among a large sample of self-harm (SH) patients. It used data from all patients admitted to four Swiss EDs between 2016 and 2019. Socio-demographic, clinical, and suicidal process-related characteristics data were evaluated against the decision for voluntary or compulsory hospitalization using t-tests, Chi-Square tests and logistic multiple regression. 2142 episodes from 1832 unique patients were evaluated. Independent predictors of decision to hospitalize included: male gender, advanced age, hospital location, depression and personality disorders, substance use, a difficult socio-economic condition, a clear intent to die, and a serious suicide attempt. Significant variables that emerged as independent predictors of compulsory hospitalization were hospital location, not having anxiety and personality disorders, being retired, having a clear intent to die, and making a serious suicide attempt. Hospital EDs had different rates of compulsory psychiatric admission. However, the decision to admit a patient for hospitalization, either voluntary or compulsory, was mainly based on clinical factors.

COVID-19-Related Psychosocial Care in General Hospitals: Results of an Online Survey of Psychosomatic, Psychiatric, and Psychological Consultation and Liaison Services in Germany, Austria, and Switzerland.

Background: The coronavirus disease 2019 (COVID-19) pandemic was accompanied by new challenges for psychosocial health care to enable the support of affected patients, their families, and staff in general hospitals. In this study, we aimed to describe the structures and procedures put in place by psychosomatic, psychiatric, and psychological consultation and liaison (CL) services in German, Austrian, and Swiss general hospitals, and to elucidate the emerging needs for cooperation, networking, and improvement. Methods: We conducted a cross-sectional online survey between December 2020 and May 2021, using a 25-item questionnaire derived from relevant literature, professional experience, and consultation with the participating professional societies. The survey was disseminated via national professional societies, relevant working and interest groups, and heads of the above-mentioned CL services. Results: We included responses from 98 CL services in the analyses, with a total response rate of 55% of surveyed hospital CL services; 52 responses originated from Germany, 20 from Austria, and 26 from Switzerland. A total of 77 (79%) of the 98 responding CL services reported that "COVID-19-related psychosocial care" (COVID-psyCare) was provided in their hospital. Among these, 47 CL services (61%) indicated that specific cooperation structures for COVID-psyCare had been established within the hospital. A total of 26 CL services (34%) reported providing specific COVID-psyCare for patients, 19 (25%) for relatives, and 46 (60%) for staff, with 61, 12, and 27% of time resources invested for these target groups, respectively. Regarding emerging needs, 37 (48%) CL services expressed wishes for mutual exchange and support regarding COVID-psyCare, and 39 (51%) suggested future changes or improvements that they considered essential. Conclusion: More than three-quarters of the participating CL services provided COVID-psyCare for patients, their relatives, or staff. The high prevalence of COVID-psyCare services targeting hospital staff emphasizes the liaison function of CL services and indicates the increased psychosocial strain on health care personnel during the COVID-19 pandemic. Future development of COVID-psyCare warrants intensified intra- and interinstitutional exchange and support. Trial Registration: ClinicalTrials.gov NCT04753242, version 11 February 2021.

The implementation and first insights of the French-speaking Swiss programme for monitoring self-harm.

AIMS OF THE STUDY: Self-harm is a major risk factor for suicide but remains poorly documented. No data on self-harm in French-speaking Switzerland exist. To address this deficiency, the Swiss Federal Office of Public Health commissioned a specific self-harm monitoring programme. We present and discuss its implementation and first findings. METHODS: Every patient aged 18–65 years presenting for self-harm to the emergency departments of the Lausanne and Neuchâtel general hospitals were included in the monitoring programme over a 10-month period (December 2016 to September 2017). Clinicians collected anonymous sociodemographic and clinical data. RESULTS: The sample included 490 patients (54.9% female and 45.1% male) for 554 episodes of self-harm, showing a higher proportion of patients aged 18–34 (49.2%) than older age groups (35–49, 33.7% and 50–65, 17.1%). Patients were mostly single (56.1%) and in problematic socioeconomic situations (65.7%). Self-poisoning was the most commonly used method (58.2%) and was preferred by women (71% of females and 42.5% of males, Fisher’s exact test, p <0.001) and the majority of patients (53.3%) had experienced at least one previous episode of self-harm. The self-harm rate was 220 per 100,000 inhabitants in Lausanne and 140 in Neuchâtel. Suicidal intent was clear for 50.6% of the overall sample, unclear for 25.1% and absent for 24.3%. It differed significantly between sites (χ2(2) = 9.068, p = 0.011) as Lausanne reported more incidents of unclear intent (27.7% versus 17.4% in Neuchâtel) and Neuchâtel more incidents with absence of intent (33.1% versus 21.3% in Lausanne). In Lausanne, patients more frequently resorted to methods such as jumping from a height (11.4%) and hanging (9%) than in Neuchâtel (1.6% and 4.9%, Fisher’s exact test, p = 0.006). CONCLUSIONS: Our results are globally consistent with previous research on self-harm. We found significant inter-site differences in methods, suicidal intent and self-harm rates. Our findings highlight the importance of implementing local self-harm monitoring to identify specific at-risk groups and develop targeted preventive intervention.