[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.

Recuperación intensificada en cistectomía radical: rol de la enfermera / No disponible

Introducción: La recuperación intensificada en cirugía, Fast-track Surgery o Enhance Recovery After Surgery (ERAS), consiste en la aplicación de una serie de medidas y estrategias pre, intra y posoperatorias con el objetivo de disminuir el estrés secundario a la intervención quirúrgica proporcionando una mejor recuperación del paciente, disminuyendo las complicaciones y la estancia hospitalaria. Las ventajas de la aplicación de programas y protocolos de rehabilitación multimodal han sido ampliamente demostradas en ensayos clínicos y meta análisis. Objetivo: Implementar un programa de recuperación intensificada para cirugía mayor urológica (cistectomía radical) que pretende mejorar la preparación preoperatoria y la recuperación posoperatoria. Material y método: En noviembre de 2016 se creó el programa de rehabilitación multimodal integrado por urólogos, psicólogos, estoma terapeutas, personal administrativo de soporte y la Unidad de Preparación para la Cirugía (UPC),compuesta de anestesiólogos y enfermeras. La muestra estuvo formada por todos los pacientes a los que se les indicó cistectomía radical. Resultados: Los resultados preliminares de una encuesta de satisfacción que cumplimentaron los pacientes un mes después de la cirugía han sido muy satisfactorios. Sobre la información preoperatoria, trato recibido, dolor, alta hospitalaria y satisfacción general se obtuvieron valores altos. Se detectaron aspectos de mejora en la dieta posoperatoria, que fueron evaluados con un menor grado de satisfacción. Se han realizado acciones de mejora que están pendientes de evaluación. Discusión/Conclusión: El éxito del programa está en la participación y estrecha colaboración de las personas implicadas en este proceso: pacientes, familias y/o cuidadores y profesionales del programa de recuperación intensificada. La atención integral, que incluye medidas pre, intra y posoperatorias, y el papel activo de los pacientes que asumen responsabilidades, son claves en la mejora de la preparación y recuperación de la cirugía

Fast-track Surgery or Enhanced Recovery After Surgery (ERAS) is a multidisciplinary approach applied to the care of the surgical patient that requires the application of pre-, intra- and post-strategies. This approach has been designed to achieve early recovery after surgical procedures. ERAS protocol has been shown to lead to a reduction in complications and shorter length of hospital stay. Validated data are available from numerous studies to show the benefits of these protocols for patients. Objective: to implement a recovery program for patients undergoing major urologic surgery (radical cystectomy). Objective: to achieve early recovery after surgical procedures and improve and optimize preoperative preparation. Material and method: in 2016 a multimodal rehabilitation program was formed by urologists, psychologists, stoma therapists, administrative staff and surgical preparation unit (SPU) integrated by anesthetists and nursing staff. The study included patients who underwent radical cystectomy. Results: the results of a patient satisfaction survey were satisfactory after the first month of surgery. Regarding preoperative, adequacy of treatment received by patients, pain, discharge from hospital and general satisfaction. Deficiencies detected are pending evaluation. Patients were less satisfied with preoperative dietary information. Conclusion: the success of the program depends on the participation and collaboration of the persons involved in this process: patient, family and/or staff members. A comprehensive approach is the best key to improve the preparation and recovery of the patient before surgery

Papel de enfermería de consultas en la implantación de un protocolo ERAS en cistectomía radical / No disponible

La cistectomía radical (CR) es un procedimiento con una elevada tasa de complicaciones. Los protocolos de rehabilitación multimodal (ERAS) optimizan al paciente para acelerar la recuperación posquirúrgica combinando estrategias pre, intra y posoperatorias. El objetivo principal de este estudio es dar a conocer el papel de la enfermera y remarcar su importancia dentro del equipo multidisciplinar. Para ello hemos elaborado una vía clínica siguiendo los protocolos ERAS, donde se estandarizan los cuidados, marcando todas las actividades donde interviene enfermería, tanto los enfocados al paciente como a la recogida de datos para la investigación y mejora de nuestra función. Entre junio de 2015 y julio de 2016 se han realizado 14 CR incluidas en vía clínica. Como conclusión, contar con el papel de la enfermería es básico para el buen desarrollo e implantación de un protocolo ERAS

Radical Cystectomy (RC) is a highly complex procedure with multiple risks for complication. Enhanced Recovery Surgery (ERAS) protocols are designed to achieve early recovery after surgical procedures by combining pre, intra and post-operative protocols. The main aim of this research is to get a better knowledge of the urology nurse and emphasize their role in multi-disciplinary teams. To do this, we elaborated a nursing care plan at following ERAS protocol, including standardized care protocols, focusing on the everyday actions of nursing practice, not only activities addressed to the patient but also data collection for medical research and capacity for improvement work. Between June 2016 and July 2016 14 RC have been performed and are included in the clinical guideline. In conclusion, it is recommended to consider the value of staff nurse involvement in decision making since it is necessary for the proper implementation of ERAS protocol in order to get a good outcome

Diagrama de flujo para prevención secundaria de la obesidad según el origen del problema: P.E.I.C. 'Bimbela' / Flow diagram for secondary prevention of obesity according to the origin of the problem: C.C.E.P. Bimbela

Objetivo: Elaboración de un diagrama de flujo que permita al profesional de Atención Primaria llevar a cabo la toma de decisiones con el paciente obeso, en función del origen del problema. Material y Métodos: Partiendo de las premisas de Virginia Henderson sobre los factores que influyen en la independencia de los pacientes para cubrir sus necesidades básicas: falta de fuerza (no puede), falta de voluntad (no quiere) o falta de conocimientos (no sabe); se ha elaborado un diagrama de decisión según 'el origen del problema': 'Proyecto Educativo Integral Comunitario (P.E.I.C.) Bimbela'. Resultados: Se captaron aquellos casos con criterios de inclusión compatibles con un programa dietoterápico no farmacológico para pacientes obesos adultos en la consulta de Enfermería Comunitaria. Se desarrolló entre Enero 2012 y Diciembre 2013 (96 semanas). Conclusión: El diagrama de flujo permite facilitar la toma de decisiones en Atención Primaria, logrando una buena adherencia al programa de adelgazamiento y mantenimiento de peso (AU)

Objective: Development of a flowchart that allows the professional Primary Care to carry out the decision with the obese patient, depending on the source of the problem. Methods: Based on the premises of Virginia Henderson, on factors influencing the independence of patients to meet their basic needs: lack of strength (can not), lack of will (do not want) or lack of knowledge (do not know); it has developed a decision diagram depends on 'the source of the problem': 'Comprehensive Comunity Educational Project (C.C.E.P.) Bimbela'. Results: Cases with criteria consistent inclusion non-pharmacologic dietoterapic program for obese adults in consultation Community Nursing. The program took place between January 2012 and December 2013 (96 weeks). Conclusion: The flowchart can provide carry out the decision in Primary Care, allowing improve adherence to weight loss and maintenance program (AU)

[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.