[Recommendations for the implementation of multi-professional staffs (MPS) in care services]. / Recommandations pour la mise en place de staffs pluriprofessionnels (SPP) dans les services de soins.

The context and constraints of modern medicine (hospital beds and caregivers' reductions, ambulatory shift, new therapeutic approaches, integration of supportive care…) combined with new societal and Health system changes (ageing population, chronic diseases, new requirements of the patients…) redefine the orientations of care and question professional practices. The participative approach (PA) as a model of team organization proposes solutions involving the skills of the various interacting caregivers and experimental knowledge and consideration of patient needs. The multi-professional staff (MPS) is a collaborative tool of this participative approach that federates a team around a health or care project personalized from the crosschecked eyes of care professionals and from a shared decision-making process. Its objective is to combine the improvement of quality of care with quality of life at work. It requires a transversal mindset of teams, intrinsic values and specific characteristics. Its organization is simple but requires some rules and we will develop the main steps to success. This article, which is the result of a joint reflection and experience of health professionals, shows the principles and wants to demonstrate the weakness of MPS. The interest of the French National Cancer Institute for this collaborative tool is an asset for further work in the perspective of generalization of MPS for all patients with chronic disease and not only for patients at palliative phase.

When and how to provide a palliative sedation in terminally ill patients? / Quand et comment mettre en place une sédation à visée palliative en fin de vie ?

When and how to provide a palliative sedation in terminally ill patients? With the introduction in the French law of sedatives practices, the professionals in palliative care are obliged to define the concepts, to name the difference kinds of sedations, to elaborate guidelines for good practice. French society of palliative care has worked to clarify the vocabulary, and to differentiate palliative sedations to their duration, their depth and the patient's consent (typology SEDAPALL). Its guidelines of 2010 have been updated in the form of three reference sheets in conjunction with a continuous deep sedation until death: how to estimate that the vital prognosis is short term? How to evaluate the refractory suffering? What are the guidelines for the pharmacological administration? The French National Authority for Health has produced a guide titled "How to realise a continuous deep sedation until death?" The present paper highlights some fundamental points of necessary steps: listening, understanding and analysing the suffering; the collegiate procedure - multi professional deliberative process, the pharmacological administration.

Quand et comment mettre en place une sédation à visée palliative en fin de vie ? L'introduction dans la loi des pratiques sédatives a obligé les professionnels de soins palliatifs à définir les concepts, nommer les différentes formes de sédations, élaborer des guides de bonne pratique. La Société française d'accompagnement et de soins palliatifs s'est efforcée de clarifier le vocabulaire et de différencier les pratiques sédatives à visée palliative selon leur durée, leur profondeur et le consentement du patient (typologie SEDAPALL). Elle a actualisé ses recommandations de 2010 sous forme de trois fiches repères en lien avec une sédation profonde et continue maintenue jusqu'au décès : Comment apprécier qu'un pronostic vital est engagé à court terme ? Comment évaluer le caractère réfractaire d'une souffrance ? Quels repères pour une mise en oeuvre médicamenteuse ? La Haute Autorité de santé élabore un guide intitulé Comment mettre en oeuvre une sédation profonde et continue jusqu'au décès ? Le présent article reprend quelques points fondamentaux des étapes incontournables : l'écoute, la compréhension et l'analyse de la souffrance, la procédure collégiale ­ processus délibératif pluriprofessionnel, la mise en oeuvre pharmacologique.

[Multidisciplinary consultation meetings: decision-making in palliative chemotherapy]. / Réunion de concertation pluridisciplinaire : comment décider d'une chimiothérapie à visee palliative?

INTRODUCTION: Multidisciplinary consultation meetings provide an opportunity for specialists from different disciplines to engage in formal discussions over diagnostic and therapeutic strategies in oncology. In complex clinical situations, specialists discuss medical decisions collectively, particularly in cases involving palliative chemotherapy. The purpose of this study was to identify the factors considered in multidisciplinary consultation meetings in deciding whether palliative chemotherapy is needed. METHODS: A study was conducted over a three-month period in an adult hematology department in order to identify the criteria used in weekly multidisciplinary consultation meetings to determine whether palliative chemotherapy is required. The study only included patients who were confirmed to be in the palliative phase by all the doctors present at the multidisciplinary consultation meetings. The criteria cover 5 areas related to patient's characteristics, patients'environment, the disease, scientific data and the objectives of palliative chemotherapy. RESULTS: The criteria considered in 100% of cases were related to the disease, the expected benefits of chemotherapy with palliative intent and patients' characteristics. The least important criteria were related to the patients' environment. Scientific data were not discussed during the multidisciplinary consultation meetings. CONCLUSION: The results show that the criteria used to determine whether chemotherapy with palliative intent is required are essentially of a medical nature. However, in palliative situations, factors related to patients' environment must be taken into account. In order to meet this requirement, it may be necessary to increase the participation of paramedical professionals and palliative care teams in multidisciplinary consultation meetings and to promote dialogue and collaboration with doctors and coordinating nurses.

[Management and follow-up of patients treated with antiretroviral prophylaxis: an evaluation of professional practices]. / Prise en charge et suivi des patients traités par prophylaxie antirétrovirale : évaluation des pratiques professionnelles.

The care management of patients treated for cases of sexual or blood exposure requires stringent clinical and biological follow-up procedures. Despite the provision of information about the importance of regular follow-up, the number of patients dropping out of screening consultations at the Hospital Lariboisière-Fernand Widal (Assistance Publique-Hôpitaux de Paris) has increased. The main purpose of this study is to improve follow-up for patients treated with anti-retroviral prophylaxis following a known sexual or blood exposure. An investigation based on 5 markers of a targeted clinical audit form ("drop-outs" or lost to follow-up, conduct of HIV serology tests, traceability of clinical, biological and compliance monitoring) was carried out. A review of practices was conducted on the basis of an analysis of patient cases over a six-month period, followed by the implementation and evaluation of corrective measures over a two-year period. A significant decline in the number of patients lost to follow-up was observed. The study shows a significant improvement in other markers: serological follow-up, compliance traceability, and clinical and biological monitoring. These results were observed between 2005 and 2007. Two distinctive effects were identified: improvement in patient care management and the quality of care, and the empowerment of actors, thereby ensuring a certain continuity of action. The decline in the rate of lost to follow-up patients and improved monitoring of compliance and iatrogenic risks confirm these effects. The overall approach is incorporated into an evaluation of professional practices.

[Analysis of fourteen French national programmes on physical activity and sports as determinants of health from 2001 to 2006]. / Analyse de quatorze actions nationales pour le déterminant de santé activités physiques et sportives en France de 2001 à 2006.

Physical activity and sports are considered as one of the determinants of health. The aim of this study is to review the rationale for the formulation of this public health issue and its integration in national action plans. The study shows that fourteen national programmes were drafted and implemented between 2001 and 2006 by seven institutions. The research methodology was based on crossing data obtained from semi-directed interviews and documents regarding the design, implementation and follow-up of these programmes. For the conditions of the success, the fourteen actions scored an average of 175.0 +/- 66.9 out of 300%. Public health actors and professionals must be given more opportunities to involve themselves and engage in developing stronger relationships and linkages, in particular with the institutional and community settings. In general, the most invested parts of a programme are the structural and operational aspects of activities. Six significant points surfaced from the study: consideration of drug use as an addictive behaviour; recognition of the psychological stress of professional athletes; acknowledgment of youth as being at high risk for doping behaviour; integration of the concept that physical activity and sports must take the benefit/risk perspective into account; and the necessity to promote health. Through the exchange of numerous local and regional experiences, an optimisation of their synergistic connections was made possible on a continuum extending from "health promotion through physical activity and sports" to "prevention of drug-use and doping behaviours". Professionals have been able to develop actions in the above-mentioned domains across this continuum that have, to date, remained isolated. Proposals are made to strengthen these dynamics. Other health determinants and public health priorities could be investigated with the same methodology.

[Anonymous and free screenings: population comparison between those conducted on-site in a testing centre and those done off-site]. / Dépistages anonymes et gratuits: comparaison de la population rencontrée en centre et en dehors des locaux.

The free and anonymous HIV testing centre of Fernand Widal Hospital (CDAG) regularly organises off-site visits to distribute information and provide screening for people at high risk in the community. To demonstrate the benefits of this action, this at-risk targeted population in the community was compared with that which comes to the centre. The individuals screened during the community off-site visits in 2005 were recorded. An equivalent number of patients coming spontaneously to the centre for screening were used as a reference point for comparison. The socio-demographic characteristics, the delay in time between the screening and return to the CDAG for the results and the screening results of the number of people infected were analysed. In total, 427 persons out of 443 were screened in 14 visits: 7,7% of persons tested off-site were infected versus 5,4% of those screened at the centre. Those who were tested off-site were in most cases infected with Hepatitis C, whereas HIV was more prevalent in those who had come to the CDAG centre. The African population (53,6%) was more significantly affected. Even when their results were positive (83,3%), 34,2% of patients tested off-site did not come to get their results versus only 8,2% of those who had come to the hospital centre for testing. The off-site community visits strengthen the role and the capacity of the CDAG to fulfil its mission because high-risk individuals are much less likely to come to the centre for screening. However measures must be taken and procedures established to improve the process and opportunity for results to be returned to the individuals, as well as follow-up and management of those who test positive for infection.