[The integration of peer support in psychiatry, or how to better support patients]. / L'intégration de la pair-aidance en psychiatrie, ou comment mieux accompagner le patient.

Peer support plays an essential role in patient recovery by encouraging a supportive approach based on experiential knowledge. It helps to create individualised care centred on life projects and individual strengths. Within the teams, the knowledge of the peer health mediator and the carers is shared. This approach helps to improve care by drawing on the depth of people's experiences and feelings, and their resilience in the face of illness.

[Bilateral breast reconstruction by DIEP flap in two stages: Technical note]. / Reconstruction mammaire bilaterale par lambeau de DIEP en deux temps : note technique.

With the rise of risk prevention surgery, more and more bilateral mastectomies are performed. These present a challenge when patients desire autologous reconstruction. Some surgeons perform reconstructions using a double DIEP flap, but this technique, which requires rapid operation and extensive experience, can sometimes be difficult to implement. Other factors may also favor a two-stage reconstruction, one breast after the other. We present here our technique to harvest two hemi-DIEP during two distinct operating times, by modifying the design of the first flap and by performing a prior autonomization of the second.

["Connected device for monitoring patients treated by prostatectomy: Implementation and qualitative assessment"]. / Dispositif connecté de suivi des patients traités par prostatectomie totale : mise en place et évaluation qualitative.

INTRODUCTION: Support care aims to improve the experience of patients. m-health is one of the tools recently developed to promote patient empowerment. The objective of this study was to evaluate the appreciation of an m-health application to enhance prostatectomy path for patients suffering from prostate cancer. METHOD: A prospective monocentric study was conducted in the urology department of the University Hospital of Rennes from February to April 2023. MyCHU application was optimized by integrating information sheets in the postoperative period after prostatectomy on sphincter rehabilitation exercises, erectile dysfunction and urinary incontinence. The questionnaire used to evaluate the usability of "MyCHU" application was the System Usability Scale (SUS). Semi-structured interviews explored the patients' feelings about the content of the information sheets and the impact on their empowerment regarding sexual disorders. RESULTS: Twelve patients participated in this study and 7 agreed to complete an interview The average SUS score was 75.58, which indicate an high usability. Patients appreciated the fact that the application structured their healthcare pathway by centralizing information. The information sheets were clear and accurate. The impact on their empowerment was positive, with a gain in their ability to take ownership of the therapies. CONCLUSION: The role of digital technology in health care has been growing in recent years. Our study has shown the interest that mobile application can bring to the patient who undergoes prostatectomy. It increases his empowerment and favor the dialogue with his surgeon.

[Enzymotherapy infusion in home hospital care]. / Perfusion d'enzymothérapie en hospitalisation à domicile.

The six pediatric care units of the Assistance publique - Hôpitaux de Paris home hospitalization service provide daily care for 150 children. A small proportion are treated for enzyme-deficiency diseases at the reference centers of the Necker-Enfants malades and Armand-Trousseau hospitals. Treatment consists of a weekly injection of enzyme therapy, lasting from three to five hours. In order to reduce the time spent by the nursery nurse, while guaranteeing the quality and safety of care, a team discussion led to the drafting of a procedure for harmonizing practices and empowering families to carry out this enzymotherapy injection.

[The Équilibres experiment, a paradigm shift in home care]. / L'expérimentation Équilibres, un changement de paradigme dans les prises en charge à domicile.

It was in 2019 that the Equilibres nursing teams began to be deployed in three metropolitan regions: Hauts-de-France, Île-de-France and Occitanie. This organizational experiment, authorized by the Article 51 of the Social Insurance Financing Law, targets home nursing and mobilizes caregivers committed to patient autonomy and responsible regarding public health expenses.

[Accompanying the pediatric/adult service transition in chronically ill patients]. / Accompagner la transition pédiatrie-service d'adultes dans la maladie chronique.

The transition is a key step for adolescents with chronic illnesses, as they are at risk of a disruption in care, complications and even mortality. Accompanying this process is based on two axes: autonomization of the young person (acquisition of knowledge and know-how in a perspective of empowerment) and structuring of the care pathway (transition measures, pediatric/adult service coordination).

[Personality profiles of students at risk of dropping out: Resilients, Overcontrollers and Undercontrollers]. / Étudiants à risque de décrochage selon le profil de personnalité : Resilients, Overcontrollers et Undercontrollers.

INTRODUCTION: Preventing students from dropping out of higher education, and particularly university, requires understanding the different factors that can lead to individuals failing to complete their studies. The role of personality in academic success or failure remains poorly understood. Block's personality profile model (Resilients, Overcontrollers, Undercontrollers) has been used to link personality traits to academic performance. The objective of this study is to apply this model to the risk factors of dropping out of higher education courses, including psychological vulnerability, level of autonomy, and the feeling of not being able to keep up. This involved validating Block's profiles in relation to the Big Five personality traits (Extraversion, Agreeableness, Conscientiousness, Neuroticism and Openness), and their links with the risk factors for dropping out. METHODS: This study is based on a quantitative survey of 196 students (mean age 21.32 years±3.11 years, with 63% females) taking higher education courses in France. Three measuring instruments were used: a French scale of Autonomy-situnomy, the French version of the Big Five Inventory (BFI-Fr) for personality traits, and the French version of the General Health Questionnaire (GHQ-28) for psychiatric morbidity. One item empirically evaluated the feeling of not being able to keep up. Data was processed using a k-average cluster analysis to establish the personality profiles, then by analysis of variance measures to evaluate the differences between them, and Bravais-Pearson correlation coefficient to identify links between risk factors and profiles. RESULTS: Conscientiousness (Control) was the trait most strongly associated with high autonomy and a low feeling of not being able to keep up. There was also a positive influence of Extraversion and Agreeableness on autonomy. On the other hand, Neuroticism scores were related to greater psychiatric morbidity, a greater feeling of not keeping up, and lower autonomy. The results for personality profiles confirm the stability of Block's profiles (Resilients, Overcontrollers and Undercontrollers) and their relevance in higher education contexts. Resilients and Overcontrollers had greater autonomy and a lower feeling of not keeping up, but Resilients had the lowest psychiatric morbidity. Undercontrollers were associated with the greatest risk factors: lowest autonomy, the highest psychiatric morbidity and the strongest feeling of not keeping up. Gender comparisons indicated that women were more affected by psychiatric morbidity, but had higher Conscientiousness and autonomy.

[Evolution of the care relationship]. / Évolution de la relation dans les soins.

There is a new role for relational aspects in care. A sociological approach can identify different dimensions of care as a collective care production. We can link this production to that of autonomy as a process in which the narrative and reflective dimensions occupy a new role. They lead to making relational modes visible by formalising them. In doing so, they participate in their transformations.

[Anorexia, the passage from adolescence to adulthood]. / Anorexie mentale, passage de l'adolescence à l'âge adulte.

Anorexia engages all those close to the patient in accepting and following the treatment process. Indeed, the continuity of the treatment depends on the quality of the connections which the person with anorexia develops with his or her parents or partner. The caregivers must be involved and understand what is at play notably with the passage from adolescence to adulthood.

[A tool for helping psychiatric patients regain their autonomy]. / Un outil pour l'autonomisation du patient en psychiatrie.

The "Hygiène de vie" ("personal health practices") group is a nursing initiative and innovative tool helping patients to regain their autonomy and facilitating their resocialisation as close as possible to their living environment. An approach centred on the links with network partners is essential, as the team of the adult day care center in Vaulx-en-Velin testifies.

A Critical Perspective on Relations between Staff Nurses and their Nurse Manager: Advancing Nurse Empowerment Theory.

This study considers empowerment in nurse-manager relations by examining how conflict is handled on both sides and how the critical social perspective has influenced these relations. The authors use inductive analysis of empirical data to explain how (1) nursing work is organized, structured, and circumscribed by centrally determined policies and practices that downplay nurses' professional judgement about patient care; (2) power is held over nurses in their relationship with their manager; and (3) nurses' response to power is to engage in strategies of resistance. The authors illustrate how power influences relations between staff nurses and managers and provide a critical analysis of the strategies of resistance that result in personal, relational, and critical empowerment among staff nurses. Through resistance, staff nurses engage in alternative discourses to counteract the prevailing neoliberal organizational and managerial discourses of efficiency and cost-effectiveness.

Cette étude se penche sur la question de l'autonomisation dans les relations entre infirmières et gestionnaires. Elle examine notamment la façon dont les conflits sont gérés par les deux camps et l'influence qu'exerce la perspective sociale critique sur ces relations. Les auteures ont recours à l'analyse inductive de données empiriques afin d'expliquer (1) la façon dont le travail infirmier est organisé, structuré et encadré par des politiques et des pratiques déterminées par des instances centrales et qui minimisent le jugement professionnel des infirmières en matière de soins aux patients; (2) le pouvoir des gestionnaires dans le cadre de leurs relations avec les infirmières; et (3) la réaction des infirmières face au pouvoir et les stratégies de résistance. Les auteures mettent en lumière l'influence qu'exerce le pouvoir sur les relations entre le personnel infirmier et les gestionnaires et présentent une analyse critique des stratégies de résistance qui mène à une autonomisation personnelle, relationnelle et critique au sein des effectifs infirmiers. Par la voie de la résistance, le personnel infirmier amorce un discours alternatif qui neutralise les discours organisationnels et gestionnaires néolibéraux dominants axés sur l'efficience et le rapport coût-efficacité.

Seeking Connectivity in Nurses' Work Environments: Advancing Nurse Empowerment Theory.

The purpose of this study was to investigate how staff nurses and their managers exercise power in a hospital setting in order to better understand what fosters or constrains staff nurses' empowerment and to extend nurse empowerment theory. Power is integral to empowerment, and attention to the challenges in nurses' work environment and nurse outcomes by administrators, researchers, and policy-makers has created an imperative to advance a theoretical understanding of power in the nurse-manager relationship. A sample of 26 staff nurses on 3 units of a tertiary hospital in western Canada were observed and interviewed about how the manager affected their ability to do their work. Grounded theory methodology was used. The process of seeking connectivity was the basic social process, indicating that the manager plays a critical role in the work environment and nurses need the manager to share power with them in the provision of safe, quality patient care.

L'objectif de cette étude était d'examiner comment s'effectue l'exercice du pouvoir par les gestionnaires et le personnel infirmier en milieu hospitalier afin d'une part de mieux comprendre ce qui favorise ou contraint l'autonomisation des infirmières et infirmiers et d'autre part de contribuer au développement de la théorie de l'autonomisation du personnel infirmier. Le pouvoir d'action faisant partie intégrante de la notion d'autonomisation, l'attention portée par les administrateurs, les chercheurs et les décideurs aux résultats du personnel infirmier ainsi qu'aux difficultés avec lesquelles celui-ci doit composer dans son milieu de travail a rendu nécessaire le développement d'une compréhension théorique plus approfondie de l'exercice du pouvoir au sein de la relation qui lie les gestionnaires aux infirmières et infirmiers. Un échantillon composé de 26 membres du personnel infirmier de 3 unités d'un hôpital de soins tertiaires de l'ouest du Canada a été observé et soumis à des entretiens portant sur la façon dont les gestionnaires influencent la capacité des infirmières et infirmiers à effectuer leur travail. Une méthodologie favorisant le développement d'une théorie enracinée dans les données empiriques a été employée. L'étude a permis de constater que la quête de liens est le processus social fondamental à l'œuvre, ce qui indique que les gestionnaires jouent un rôle essentiel dans le milieu de travail et que le personnel infirmier a besoin que ceux-ci partagent avec lui l'exercice du pouvoir pour assurer la prestation aux patients de soins sécuritaires et de qualité.

The Autonomization Principle in Vascularized Flaps: An Alternative Strategy for Composite Tissue Scaffold In Vivo Revascularization.

Autonomization is a physiological process allowing a flap to develop neo-vascularization from the reconstructed wound bed. This phenomenon has been used since the early application of flap surgeries but still remains poorly understood. Reconstructive strategies have greatly evolved since, and fasciocutaneous flaps have progressively replaced muscle-based reconstructions, ensuring better functional outcomes with great reliability. However, plastic surgeons still encounter challenges in complex cases where conventional flap reconstruction reaches its limitations. Furthermore, emerging bioengineering applications, such as decellularized scaffolds allowing a complex extracellular matrix to be repopulated with autologous cells, also face the complexity of revascularization. The objective of this article is to gather evidence of autonomization phenomena. A systematic review of flap autonomization is then performed to document the minimum delay allowing this process. Finally, past and potential applications in bio- and tissue-engineering approaches are discussed, highlighting the potential for in vivo revascularization of acellular scaffolds.

Practitioner Empowerment, Older Adult Mistreatment, and Dementia.

Although some studies have revealed practitioner disempowerment in cases of older adult mistreatment, this experience is poorly understood. In addition, dementia and contextual influences further complicate cases; yet,  little is known about the experience of practitioners with this complexity. This critical inquiry, based on Critical social theory, critical consciousness, and professional agency, aimed to address these gaps. Fifty-one practitioners from diverse health care and social service disciplines from rural and urban communities in Northeastern Ontario participated in interviews, journals, and focus groups. Analysis of data revealed the need for empowerment within a perpetual cycle of non-resolution, to refocus on legal clarity and intervention versus the current legal complexity and education focus, and to develop adequate infrastructure to support interprofessional efforts. The infusion of this knowledge into policy, practice, and research has great potential to improve outcomes for older adults with dementia who are mistreated in their homes.

[How to reconcile therapeutic patient education and care pathology in oncology: Application in head and neck neoplams]. / Comment concilier éducation thérapeutique des patients et parcours de soin en cancérologie : application pour les voies aérodigestives supérieures.

Therapeutic education is an educational approach that allows the patient and his entourage to acquire or maintain the skills necessary to manage their daily lives. It requires a global care of patients and caregivers and is much broader than a learning of technical gesture. While their development is encouraged in the plan cancer 2014-2018, few programs exist in cancer surgery because the process is very cumbersome to implement due to a very strict administrative framework. In the absence of permission from the Regional health agency, "therapeutic education" term should not be used under penalty of a fine. The aim of this article is to present the principles and rules of therapeutic education defined by the french « Haute Autorité de Santé ¼ and to illustrate them through the example of our therapeutic education program for patients with tracheostomy and/or gastrostomy. The patient pathway with the chronology, the speakers, the competency references, the possible interactions with the announcement scheme as desired by the French National Cancer Institute are specified. This information will facilitate the filling of the program authorization in order to participate in the development of therapeutic education in our specialty.

The Role and Effectiveness of Telephone Peer Coaching for Adult Patients With Type 2 Diabetes.

OBJECTIVES: This pilot investigated the feasibility and viability of recruiting, training and pairing peer coaches with patients with type 2 diabetes and whether telephone coaching enhances health outcomes. METHODS: Using a 1-group longitudinal design, 115 English-speaking adult patients with type 2 diabetes living in a health region were recruited by educators. Measures were glycated hemoglobin levels, self-reported health, fatigue and pain, activation, empowerment, self-efficacy, depression, communication with physician, medication adherence, health literacy and health-care utilization. The intervention consisted of weekly 30-min telephone calls by coaches to patients for a period of 6 months. Outcome measures were completed at baseline and at 6 and 12 months. A 1-way repeated-measures analysis of variance assessed whether the coaching program improved the outcomes of the patients from baseline to 6 and 12 months. RESULTS: Process recording demonstrated that peer coaches can be recruited, trained and paired with patients with type 2 diabetes for a 26-week period. At 12 months, the mean patient glycated hemoglobin level decreased by 9%; general health improved by 7%; fatigue decreased by 15%; activation increased by 15%; empowerment increased by 10%; self-efficacy increased by 23%; depression level decreased by 24%; and communication with physician increased by 22%. CONCLUSIONS: This pilot found that a pragmatic low-cost telephone peer-coaching intervention assisted patients with type 2 diabetes to self-manage their diabetes in better ways. Future replication and randomized trials are needed to validate these preliminary findings. Involving volunteer peers in the spectrum of diabetes care is a cost-effective way of providing additional support and continuity of care.

Interplay between economic empowerment and sexual behaviour and practices of migrant workers within the context of HIV and AIDS in the Lesotho textile industry.

Economic empowerment brings with it a wide range of consequences, both positive and negative. The objective of this paper was to examine the relationship between economic empowerment and the sexual behaviour and practices of migrant workers within the context of HIV and AIDS in the Lesotho textile industry. Data for this paper were extracted from the findings of a larger study which had been conducted concerning HIV and AIDS in the textile industry in Lesotho. Using in-depth interviews, data were collected from 40 participants who were purposively selected from five factories which had been chosen randomly. Empowerment theory was used as a lens to provide meanings for the experiences of the participants. The findings show that the participants were empowered only in certain respects in terms of Kabeer's empowerment model of 'power to' and 'power within', on one hand, and in terms of Malhotra's comprehensive empowerment framework at the household level, on the other, as being employed in the industry enabled them to participate in the economy. Employment in the sector provided the participants with the means to be able to acquire basic needs and the ability to participate in household decision-making: for the female participants, the ability to make independent sexual decisions was also enhanced. These improvements were greeted enthusiastically, particularly by the female participants, given their previously disadvantaged status as a result of coming from rural patriarchal villages with gender-defined hegemonic notions of respectability. The findings also indicate that environmental factors and others, such as meagre salaries, encouraged some of the female workers to engage in transactional sex, while some of the male participants tended to increase their sexual relationships as a result of acquiring employment and income from the industry. It is the contention of the authors of this study that true empowerment requires both vital resources and individual and collective participation, particularly for the women, who are more vulnerable than men. Finally, we conclude that the opportunities provided by economic empowerment have given the participants a new social meaning for their situation and an awareness about their place in power relations.

Comparing performance of Tabriz obstetrics and gynaecology hospitals managed as autonomous and budgetary units using Pabon Lasso method.

BACKGROUND: Considering governmental scrutiny and financial constraints in medicine, the need for improved performance, which can provide acceptable care for medical consumers, leads to the conduct of new managerial methods to improve effectiveness. AIMS: This study aimed to compare performance indicators of obstetrics and gynaecology teaching hospitals in Tabriz. METHOD: A longitudinal, retrospective study was conducted to compare performance indexes of Tabriz obstetrics and gynaecology teaching hospitals during 2010-2012. Al-Zahra is Tabriz's central teaching hospital in obstetrics and gynaecology that is authorised under a board of trustees as an autonomous hospital and Taleghani hospital is managed under centralised administration. Study variables included: Average Length of Stay (ALOS), Bed Occupancy Rate (BOR), and Bed Turnover Ratio (BTR). The data was extracted via the Hospital Information Systems (HIS) within the hospitals' admission and discharge units. Pabon Lasso model was used to assess hospital performance. Data was analysed and graphs were plotted using the SPSS-17 software package. RESULTS: According to study findings, overall ALOS in Al-Zahra hospital is 3.15 (2.15) days (1.88 (0.97) days for prenatal wards and 6.13 (0.97) days for neonatal wards) and ALOS in Taleghani Hospital is 3.37 (3.09) days (1.74 (0.14) days for perinatal wards and 5.96 (3.55) days for neonatal wards). In this regard, Al-Zahra hospital holds the maximum BOR with 86.92 per cent and the minimum BOR was attributed to Taleghani hospital at 68.44 per cent (P<0.001). Study findings indicate that BOR in neonatal wards is greater than prenatal wards. On the other hand, BOR in Al-Zahra is greater than Taleghani (P<0.001), whereas BOR trend shows an increasing pattern in both hospitals. CONCLUSION: Results of this study showed that the performance of Al- Zahra Hospital is better than Taleghani Hospital. These two hospitals are similar in different aspects except Al-Zahra is under a board of trustees and Taleghani is not. We should also consider that Al-Zahra Hospital has more facilities than Taleghani.

Tradições Intelectuais na Ciência Política Brasileira Contemporânea / Intellectual Traditions in Contemporary Brazilian Political Science / Traditions Intellectuelles en OEuvre dans les Sciences Politiques Brésiliennes Contemporaines / Tradiciones Intelectuales en la Ciencia Política Brasileña Contemporánea

RESUMO O artigo analisa o papel de diversas tradições intelectuais na estruturação da produção da Ciência Política brasileira. Toma-se como referência a produção veiculada nos 23 periódicos nacionais A1, A2 e B1 listados no Qualis da área de Ciência Política, relativa ao triênio de 2010-2012. A partir de categorias como periódicos, áreas temáticas e abordagens, usa-se técnicas de redução dimensional e verifica-se que certas tradições intelectuais - "humanística" e "científica", nomotética e ideográfica - contribuem para determinar essa estrutura. Oposições específicas, como entre tradições "teórica" e "empírica", também contribuem para estruturar a oposição. Argumenta-se que a Ciência Política brasileira autonomiza-se privilegiando uma tradição científica mais ortodoxa.

ABSTRACT The following article analyzes the role played by various intellectual traditions in the structuring of the output of Brazilian political science, referring to 23 national A1, A2 and B1 journals listed in the field of political science by the Qualis classification system and published in the 2010-2012 triennium. Based on categories such as journals, thematic areas and approaches, dimensional reduction techniques are used, demonstrating that certain intellectual traditions, whether "humanistic", "scientific", nomothetic or ideographic, contribute to the determining of this structure. Specific oppositions, such as those between "theoretical" and "empirical" traditions, also contribute to the structuring of this opposition. The article argues that Brazilian political science is developing its own identity, favoring a more orthodox scientific tradition.

RÉSUMÉ Cet article analyse le rôle de diverses traditions intellectuelles dans la structuration de la production des sciences politiques brésiliennes. On prendra comme référence la production véhiculée par les 23 périodiques nationaux de sciences politiques A1, A2 et B1 répertoriés dans la banque de données Qualis entre 2010 et 2012. À partir de catégories telles que périodiques, domaines thématiques et approches, on a utilisé des méthodes de réduction dimensionnelle pour constater que certaines traditions intellectuelles - "humanistique" et "scientifique", nomothétique et idéographique - ont contribué à déterminer cette structure. Des oppositions spécifiques, comme entre traditions "théorique" et "empirique", ont également contribué à structurer cette opposition. Nous soutenons ici que les sciences politiques brésiliennes ont néanmoins développé une identité propre en privilégiant une tradition scientifique plus orthodoxe.

RESUMEN El artículo analiza el rol de diversas tradiciones intelectuales en la estructuración de la producción de la ciencia política brasileña. Se toma como referencia la producción publicada en los 23 periódicos nacionales A1, A2 y B1 enumerados en el Qualis del área de la ciencia política, referente al trienio de 2010 a 2012. A partir de categorías como periódicos, áreas temáticas y enfoques se utilizan técnicas de reducción dimensional y se verifica que determinadas tradiciones intelectuales - "humanística" y "científica", nomotética e ideográfica - contribuyen a determinar esa estructura. Oposiciones específicas, como entre las tradiciones "teórica" y "empírica", también contribuyen a estructurar la oposición. Se plantea que la ciencia política brasileña se hace autónoma privilegiando una tradición científica más ortodoxa.