[The selection of patients in palliative care units, a necessary condition for maintaining care]. / La sélection des patients en unités de soins palliatifs, une condition nécessaire du maintien du care.

Title: La sélection des patients en unités de soins palliatifs, une condition nécessaire du maintien du care. Abstract: « Les humanités en santé : approches de terrain ¼ sont coordonnées par Claire Crignon, professeure d'histoire et de philosophie des sciences à l'université de Lorraine, qui a créé le master « humanités biomédicales ¼ à Sorbonne université.

[Non-urgent patients in emergency departments: Prioritisation, orientation, and selection through the prism of social sciences]. / Les patients dits « non urgents ¼ aux urgences - Priorisation, orientation et sélection au prisme des sciences sociales.

Emergency departments overcrowding is often attributed to inappropriate use by patients who ought to be treated in primary care. This article challenges this assertion by examining the articulation of medical and social definitions of non-urgent patients within medical and sociological literature, and how they translate into prioritisation, selection and triage criteria. It shows that triage practices, which are necessary for prioritising life-threatening emergencies are not only based on clinical criteria, but also incorporate moral and social considerations which can lead to discrimination and hinder equitable access to care, particularly for the most vulnerable patients.

Title: Les patients dits « non urgents ¼ aux urgences - Priorisation, orientation et sélection au prisme des sciences sociales. Abstract: Le phénomène actuel de saturation des services d'urgences est souvent attribué aux passages abusifs des patients relevant de la médecine de ville. Cet article, fondé sur une revue de la littérature médicale et sociologique, interroge cette assertion en examinant l'articulation des définitions médicales et sociales des patients qualifiés de « non urgents ¼ et les manières dont elles se traduisent dans des critères de priorisation, de sélection et d'orientation. Il en ressort que les pratiques de tri, nécessaires pour prioriser les cas d'urgence vitale, ne se fondent pas seulement sur des critères cliniques mais intègrent également des considérations morales et sociales qui peuvent mener à des discriminations et entraver l'accès équitable aux soins, en particulier pour les patients les plus vulnérables.

COVID-19 Health Crisis and Chronic Illness: Protocol for a Qualitative Study.

BACKGROUND: The acute nature of the COVID-19 pandemic has put a strain on health resources that are usually dedicated to chronic illnesses. Resulting changes in care practices and networks have had major repercussions on the experience of people with chronic disorders. OBJECTIVE: This paper presents the protocol of the Parcours, Associations, Réseau, Chronicité, Organisation, Usagers, Retour d'expérience, Soins (PARCOURS)-COVID study. The aim of this study is to evaluate the effects of reorganization of the health system on the usual care network of patients with chronic illness, which fosters and qualifies the quality and continuum of care provided. The first objective of this study is to document these patients' experiences through transformations and adaptations of their network, both in the practical dimension (ie, daily life and care) and subjective dimension (ie, psychosocial experience of illness and relationship to the health system). The second objective of the study is to understand and acknowledge these reorganizations during the COVID-19 lockdown and postlockdown periods. The third objective is to produce better adapted recommendations for patients with chronic illness and value their experience for the management of future health crisis. METHODS: The PARCOURS-COVID study is a qualitative and participatory research involving patient organizations as research partners and members of these organizations as part of the research team. Three group of chronic diseases have been selected regarding the specificities of the care network they mobilize: (1) cystic fibrosis and kidney disease, (2) hemophilia, and (3) mental health disorders. Four consecutive phases will be conducted, including (1) preparatory interviews with medical or associative actors of each pathology field; (2) in-depth individual interviews with patients of each pathology, analyzed using the qualitative method of thematic analysis; (3) results of both these phases will then be triangulated through interviews with members of each patient's care ecosystem; and finally, (4) focus groups will be organized to discuss the results with research participants (ie, representatives of chronic disease associations; patients; and actors of the medical, psychosocial, and family care network) in a research-action framework. RESULTS: The protocol study has undergone a peer review by the French National Research Agency's scientific committee and has been approved by the research ethical committee of the University of Paris (registration number: IRB 00012020-59, June 28, 2020). The project received funding from August 2020 through April 2021. Expected results will be disseminated in 2021 and 2022. CONCLUSIONS: Our findings will better inform the stakes of the current health crisis on the management of patients with chronic illness and, more broadly, any future crisis for a population deemed to be at risk. They will also improve health democracy by supporting better transferability of knowledge between the scientific and citizen communities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/28728.

Health professionals prepared for the future. Why Social Sciences and Humanities teaching in Medical Faculties matter.

This article was migrated. The article was marked as recommended. A public debate took place place in France in 2018 concerning ethical and social issues of biomedicine and life science and technologies. As faculty members of French medical schools and scholars in Social Sciences and Humanities, we contributed to introduce the central theme of health professionals education. What roles and what place should we assign to the social sciences and Humanities in preparing health professionals who will work in a transforming and largely unpredictable context? In this paper, we list 4 crucial issues for the present and the future of healthcare profession, concerning changes of medical roles; new biomedical concepts and innovations; long term consequences on health social contract; ethical issues in health care daily life settings. Then, we list 4 kinds of resources that are brought to students by Social Sciences and Humanities courses. They concern the connection to patients's experiences the social and cultural construction of these experiences; the social responsibility of medical doctors; and the independence of their professional judgments. This is a plea for the development of reflexivity and critical thought backed up by well identified, well integrated and sufficiently developed Social Sciences and Humanities courses in French medical schools.

Is laparoscopic live donor hepatectomy justified ethically?

Live donor liver transplant (LDLT) was first reported in the 1990s and quickly raised ethical considerations, mainly related to the risk brought to the donor. The question of donor safety was even more accurate with the occurrence of laparoscopy, a technique which could allegedly increase the risk of severe intraoperative complications. Besides the questions of justice and autonomy, donor safety remains the main ethical debate of LDLT. Considering the lack of comparative assessment of postoperative outcomes, the Jury of the last Consensus meeting held in Japan in 2014 called for the creation of international registries to help to determine the benefit/risk ratio of laparoscopic donor hepatectomy. Since randomized studies are very unlikely to occur, benchmarking comparisons, between liver and kidney donors for instance, may also help to define standard practice. At last, donors' points of view should also be taken into account in the evaluation of those innovative procedures.

[Improved understanding of the experience of physical activity after a cancer from a philosophy of health perspective]. / Mieux comprendre l'expérience de l'activité physique après un cancer grâce à la philosophie de la santé.

We found that this programme had a positive impact on physical activity and four different types of profiles regarding the role of physical activity in the woman's life and personal values were identified. These results support the need for a better understanding by health promotion professionals of women's life values in order to more effectively help them after breast cancer treatment. .

[Benchmarks for interdisciplinary health and social sciences research: contributions of a research seminar]. / Jalons pour une recherche interdisciplinaire en santé et en sciences humaines et sociales: apports d'un séminaire de recherche.

This article proposes a reflection on an interdisciplinary seminar, initiated by philosophy and sociology researchers and public health professionals. The objective of this seminar was to explore the mechanisms involved in setting up and conducting interdisciplinary research, by investigating the practical modalities of articulating health and human and social sciences research in order to more clearly understand the conditions, tensions and contributions of collaborative research. These questions were discussed on the basis of detailed analysis of four recent or current research projects. Case studies identified four typical epistemological or methodological issues faced by researchers in the fields of health and human and social sciences: institutional conditions and their effects on research; deconstruction of the object; the researcher's commitment in his/her field; the articulation of research methods. Three prerequisites for interdisciplinary research in social and human sciences and in health were identified: mutual questioning of research positions and fields of study; awareness of the tensions related to institutional positions and disciplinary affiliation; joint elaboration and exchanges between various types of knowledge to ensure an interdisciplinary approach throughout all of the research process.

Person-centredness: conceptual and historical perspectives.

PURPOSE: The definition and aims of rehabilitation are both topics of frequent debate. Recently several authors have suggested defining rehabilitation and its goals in terms of 'person-centredness'. However such attempts to define rehabilitation in this way have not occurred without running into their own difficulties and criticisms. Consequently, one may question whether person-centredness is a good candidate to characterize and define rehabilitation. The purpose of this article is to reflect upon the historical background and conceptual underpinnings of this term and their relevance for understanding contemporary person-centred rehabilitation. METHOD: We conducted a conceptual and historical analysis of the notion of person-centredness in relation to rehabilitation. We ask first whether person-centredness has a consistent and fixed definition and meaning? Secondly, where does person-centredness come from, what is its conceptual history and does an historical approach enable us to identify a unique source for person-centredness? RESULTS: In the context of rehabilitation, we have identified four main understandings or interpretations of the term person-centredness, each of which denotes several ideas that can be, in turn, interpreted in quite different ways. Thus the concept of person-centredness in rehabilitation has multiple meanings. The conceptual history indicates that person-centredness has diverse meanings and that it has been used in a variety of contexts somewhat unrelated to disability and rehabilitation. Moreover, there does not seem to be any strict relationship between person-centredness as it is used in the context of rehabilitation and these prior uses and meanings. CONCLUSION: Person-centredness has an ancient pedigree, but its application in the field of rehabilitation raises both practical and theoretical difficulties. It may be that rehabilitation might get a better sense of what it should be and should do by focusing less on the rhetoric of person-centredness and by putting more emphasis on the investigation and operationalization of its key conceptual components.

Why is rehabilitation not yet fully person-centred and should it be more person-centred?

AIMS: It is a generally shared opinion that rehabilitation is not (yet) 'fully person-centred' and that it should be more. For a certain number of authors, this deficit in person-centredness has originated from the important weight of a 'medical framework' within rehabilitation. In this paper, we will discuss this criticism and its corollary: the idea that rehabilitation is bound to choose between a non-medical and a medical paradigm, since there is a fundamental contradiction between medicine and person-centredness. In the first section of the paper, we will examine the conceptual history of rehabilitation and question whether this history can really be summarized as a 'shift from a medical approach to a person-centred approach'. In the second section, we will question assumptions and suggestions that have been made to develop person-centredness in rehabilitation. In the third section, we will discuss what might be gained but also what might be lost by reinforcing person-centredness in rehabilitation. KEY FINDINGS AND IMPLICATIONS: (i) The history of rehabilitation is complex with several stages and paradigm shifts. Furthermore, these paradigms do not succeed one another but overlap. It would therefore be erroneous to reduce the history of rehabilitation to merely a shift 'from a medical approach to a person-centred approach'. (ii) Several proposals of how to make rehabilitation more person-centred are found within the literature. However, none of these appears satisfactory with each leading to theoretical and practical difficulties. (iii) Although person-centredness has unquestionably contributed to the overall progress of rehabilitation, it is not certain that more person-centredness is the solution to current challenges to rehabilitation. CONCLUSION AND RECOMMENDATIONS: In some ways, the challenge rehabilitation faces is the need to transpose and adapt a notion (person-centredness) that has emerged from fields that are in fact unrelated to disability such as, for example, clinical psychology. The difficulties encountered are therefore not so much related to the particular dominance of a 'medical model' in rehabilitation than they are to the complexities of the concept of disability. We argue that one way forward might be to clarify further the respective role of the medical and non-medical aspects of rehabilitation in ways that go beyond what has been already achieved in either the ICIDH or ICF but which is still unsatisfactory or incomplete in many respects.