[The grafted frontalis muscle flap: A simple and efficient lining for aesthetic reconstruction of full thickness nasal sidewall defects]. / Le lambeau du muscle frontal greffé : une technique de doublure simple et efficace dans les rhinopoïèses esthétiques transfixiantes de la face latérale du nez.

The reconstruction of thin and well-vascularized lining is capital for the aesthetic reconstruction of full thickness nasal defects. The mucosal flaps allow such reconstruction, but their dissections are difficult and not always possible, particularly for large defects of the nasal sidewall unit. The grafted frontalis muscle flap allows easily such lining reconstruction. This technique includes 3 stages, all done under local anaesthesia: 1st stage: a vertical paramedian forehead flap is classically raised and it's undersurface is full thickness skin grafted, it is then repositioned on it's site for 4 weeks; 2nd stage: this flap is raised again and split at the level of fat, just superficial to the muscle, in two flaps: the full thickness skin grafted frontalis muscle flap for the lining; and the forehead flap, without it's frontalis muscle, for the skin coverage; a sculpted cartilaginous graft is inserted between these two flaps and sutured to the lining with the aim of obtaining a symmetrical nasal sidewall and the necessary rigidity to avoid the heminasal collapse during inspiration; 3rd stage: 4 weeks after the second stage, the pedicles of these two flaps are severed. No vascular problems and no infections were seen with this technique in 11 patients operated on for evolved basal cell carcinoma of the nasal sidewall since 2018. The aesthetic results were always very satisfactory without any discomfort during breathing.

[Psyperinatal mobile teams: News and prospects]. / Équipes mobiles psypérinatales : actualités et perspectives.

Perinatal psychiatry is now defined in the French Public Health Code as joint parent-baby care. It focuses on parent-baby interactions, the baby's development and the parents' psychological health. "Mobile teams" for joint (parent-baby) care, the very first of which date back to the 1990s, have been developed modestly thanks to the call for perinatal psychiatry projects in 2021 and those for child and adolescent psychiatry since 2019. These mobile units complement full-time outpatient and inpatient joint care units.

[Visibility of patients and respect for their privacy: reconciling apparently contrary imperatives in the intensive care unit]. / Visibilité des patients et respect de leur intimité : concilier des impératifs apparemment contraires en service de réanimation.

Rigorous monitoring of vital functions in intensive care requires optimal visibility of patients and their environment. Conversely, respect for privacy is an ethical imperative to respect. Liquid crystal electrical film is a device that can be applied to windows and can take opaque or transparent form on demand. Its use could satisfy the visibility of patients and respect for their privacy.

Preterm infant mental health in the neonatal intensive care unit: A review of research on NICU parent-infant interactions and maternal sensitivity.

Caregiving relationships in the postnatal period are critical to an infant's development. Preterm infants and their parents face unique challenges in this regard, with infants experiencing separation from parents, uncomfortable procedures, and increased biologic vulnerability, and parents facing difficulties assuming caregiver roles and increased risk for psychological distress. To better understand the NICU parent-infant relationship, we conducted a review of the literature and identified 52 studies comparing observed maternal, infant, and dyadic interaction behavior in preterm dyads with full-term dyads. Eighteen of 40 studies on maternal behavior found less favorable behavior, including decreased sensitivity and more intrusiveness in mothers of preterm infants, seven studies found the opposite, four studies found mixed results, and 11 studies found no differences. Seventeen of 25 studies on infant behavior found less responsiveness in preterm infants, two studies found the opposite, and the remainder found no difference. Eighteen out of 14 studies on dyad-specific behavior reported less synchrony in preterm dyads and the remainder found no differences. We identify confounding factors that may explain variations in results, present an approach to interpret existing data by framing differences in maternal behavior as potentially adaptive in the context of prematurity, and suggest future areas for exploration.

Las relaciones de prestación de cuidados en el período postnatal son críticas para el desarrollo del infante. Los infantes nacidos prematuramente y sus progenitores enfrentan retos únicos a este respecto, con los infantes que experimentan la separación de sus progenitores, procedimientos incómodos, así como un aumento en la vulnerabilidad biológica; y los progenitores enfrentando dificultades al asumir el papel de cuidadores y el aumento de riesgo de angustia sicológica. Para comprender mejor la relación progenitor-infante en la Unidad Neonatal de Cuidados Intensivos (NICU), llevamos a cabo una revisión de la literatura e identificamos 52 estudios que comparan la observada conducta de interacción materna, del infante y de la díada en díadas de infantes prematuros con díadas de infantes de gestación completa. Dieciocho de 40 estudios sobre la conducta materna encontraron una menos favorable conducta, incluyendo una baja en la sensibilidad y más intrusión en el caso de madres de infantes prematuros; 7 estudios encontraron que se daba la situación opuesta; 4 estudios presentaron resultados mixtos; y 11 estudios no encontraron diferencias. Diecisiete de 25 estudios sobre el comportamiento del infante encontraron una menor capacidad de respuesta en infantes prematuros; dos estudios encontraron que se daba la situación opuesta; y el resto de los estudios no encontró ninguna diferencia. Ocho de 14 estudios sobre el comportamiento específico de la díada reportaron menos sincronía en las díadas con infantes prematuros y el resto de los estudios no encontró ninguna diferencia. Identificamos factores confusos que pudieran explicar las variaciones en los resultados, presentamos un acercamiento para interpretar la información existente por medio de enmarcar las diferencias en la conducta materna como potencialmente adaptable en el contexto del nacimiento prematuro, y sugerimos futuras áreas para ser exploradas.

Les relations de soin dans la période postnatale sont critiques pour le développement du nourrisson. Les bébés nés avant terme et leurs parents font face à des défis uniques à cet égard, avec les bébés faisant l'expérience de la séparation des parents, des procédures désagréables et difficiles, et une vulnérabilité biologique accrue, et les parents faisant face aux difficultés assumant des rôles de soignants et étant à risque plus élevé de détresse psychologique. Afin de comprendre la relation parent-nourrisson USIN nous avons passé en revue toutes les recherches et identifié 52 études comparant le comportement d'interaction dyadique, maternel et du nourrisson chez des dyades prématurées avec des dyades à plein terme. 18 des 40 études sur le comportement maternel ont trouvé un comportement moins que favorable, y compris une sensibilité décrue et plus d'intrusion chez les mères de nourrissons prématurés, 7 études ont trouvé le contraire, 4 études ont trouvé des résultats mélangés, et 11 études n'ont trouvé aucune différence. 17 études sur 25 sur le comportement du nourrisson ont trouvé une réaction moindre chez les nourrissons prématurés deux études ont trouvé le contraire, et le reste n'a trouvé aucune différence. 8 études sur 14 sur le comportement spécifique à la dyade ont fait état de moins de synchronie chez les dyades avant terme et les autres études n'ont trouvé aucune différence. Nous identifions des facteurs confondants qui pourraient expliquer des variations dans les résultats et nous présentons une approche pour interpréter les données existantes en cadrant des différences dans le comportement maternel comme étant potentiellement adaptatives dans le contexte de la prématurité et nous suggérons des domaines futurs d'exploration.

Opening the black box of hospitalizations in French high-secure psychiatric forensic units.

INTRODUCTION: Basic epidemiological data are rare concerning the activity of specialized forensic psychiatric facilities in France. Here, we investigated the activity of the ten (640 beds) French "units for difficult patients" (unités pour malades difficiles [UMDs]). METHOD: We used the Programme de médicalisation des systèmes d'information (PMSI) database to describe the characteristics and evolution of psychiatric hospitalisations in UMDs between 2012 and 2021, as well as the age, sex, and principal diagnoses of the patients hospitalized in these facilities. RESULTS: Between 2012 and 2021, 4857 patients were hospitalized in UMDs (6082 stays). Among them, 897 (18.5%) had more than one stay. The number of admissions ranged from a minimum of 434 to a maximum of 632 per year. The number of discharges ranged from a minimum of 473 to a maximum of 609 per year. The mean length of stay was 13.5 (SD: 22.64) months with a median of 7.3 months (IQR: 4.0-14.4). Among the 6082 stays, 5721 (94.1%) involved male patients. The median age was 33 (IQR: 26-41) years. The most frequent principal psychiatric diagnoses were psychotic disorders and personality disorders. CONCLUSION: The number of individuals hospitalized in specialized forensic psychiatric facilities has been stable for 10 years in France and remains lower than in most European countries.

Pharmacist tracking and correction of medication errors: An improvement project in the observation ward of the emergency department.

OBJECTIVE: The risk of medication errors is high in emergency departments. Implementation of medication reconciliation activity complemented by pharmaceutical analysis of prescription is an effective way to reduce drug related problems. This study aimed to assess the potential clinical impact of these activities to prevent medication errors for the observation ward patients. The secondary objective was to assess these activities' cost-avoidance and benefit-to-cost ratio. MATERIAL AND METHODS: This study was conducted in a 16-bed unit, over a 5-month period. The patients' demographic and treatment details, and data from pharmaceutical activities were collected and analyzed by a pharmacist. Two pharmacists and an emergency physician assessed the potential clinical impact of medication errors. RESULTS: Medication reconciliation for 250 patients (15.7% of 1589 admitted patients) and pharmaceutical analysis of prescription for 302 patients (19%) were performed by the pharmacist. Medication reconciliation detected 752 errors in 197 patients; 19% were related to high-risk medications and 14% had a potential clinical impact assessed as major, critical or fatal. Pharmaceutical analysis of prescription revealed 159 drug related problems in 118 patients; of which 26% involved high-risk medications and 24% had a potential clinical impact assessed "at least major". In total, 16% of pharmacist interventions had a potential clinical impact assessed "at least major" in 33% of patients: this represents 1.8 pharmacist interventions formulated per day. CONCLUSION: The presence of a pharmacist in the observation ward of the emergency department is useful in detecting iatrogenic drug related problems and reducing their medical impact. The benefit-to-cost ratio is favorable for the hospital.

Non-contrast computed tomography-based factors in predicting ESWL success: A systematic review and meta-analysis.

PURPOSE: We assessed the efficacy of some predictive factors that can be measured with non-contrast computed tomography and may affect ESWL success with a systematic review and meta-analysis. MATERIALS AND METHODS: All data sources were broadly investigated up to April 2022. Data were extracted from the relevant studies and analyzed with RevMan software. In a random effects model, standard mean difference (SMD) and risk ratio (RR) values were given with 95% confidence intervals. RESULTS: In total, pooled analysis included 7148 patients in 43 studies. The combined effect estimate showed significant differences between the ESWL success and ESWL failure groups in terms of Hounsfield unit (HU), Hounsfield density (HD), skin to stone distance (SSD), ureteral wall thickness (UWT), stone volume, stone area, abdominal fat parameters, diameter of proximal ureter, and hydronephrosis. However, perinephric stranding and renal cortical thickness were not found to be statistically significant between the study groups. CONCLUSIONS: HU, HD, SSD, UWT, stone volume, stone area, abdominal fat parameters, diameter of proximal ureter and hydronephrosis are effective factors for prediction of ESWL success. It is important to decide on treatment before the procedure for stones with appropriate diameter for ESWL.

[Sexuality in the cognitive-behavioral unit]. / La sexualité en unité cognitive et comportementale.

Sexuality in geriatrics poses ethical dilemmas, particularly for patients with cognitive disorders. What is the place of consent, presumption of competence and caregiver responsibility? A tool structuring these questions has facilitated collective decisions in the cognitive-behavioral unit to ensure respectful support for intimate relationships between patients. Ongoing reflection remains essential for optimal care.

[Fatherhood in the mother-baby unit: the experience of the Panda unit]. / La paternité en unité mère-bébé : l'expérience de l'unité Panda.

Mother-baby units offer a care environment that is conducive to better care for fathers. However, these units still need to evolve in terms of organization and attitude to care. The systematic use of pre- and postnatal interviews is an interesting approach to consider.

[Involuntary psychiatric care for incarcerated people: a descriptive study of 73 consecutive judge-ordered discharges from psychiatric hospitalisation in France]. / Soins psychiatriques sans consentement pour les personnes détenues : une étude descriptive de 73 mainlevées consécutives en unité hospitalière spécialement aménagée.

INTRODUCTION: The procedure of involuntary psychiatric hospitalization has been recently modified in France. Indeed, since 2011, a liberty and custody judge is appointed for each measure, to guarantee the rights of psychiatric inpatients and to prevent abusive hospitalizations. As a result, if procedural errors are noted, the liberty and custody judge may order the immediate ending of the psychiatric hospitalization. To date, only two studies described the reasons for judiciary discharge from involuntary psychiatric hospitalizations, but no study has been conducted in forensic psychiatric units for incarcerated people. The objective of the current study was to describe the main reasons judges use to decide on the irregularity of the hospitalization (against the opinion of psychiatrists) for detained patients, and to compare these reasons with those for patients in the community psychiatric unit. METHODS: We included all the discharges ordered between 2011 and 2018 in two units of the same hospital: a forensic psychiatric unit for incarcerated people and a community involuntary psychiatric unit. We extracted sociodemographic characteristics and judiciary information such as date of discharge, resason fordischarge, presence of the patient at the hearing. We analyzed the judge-ordered discharge rate (corresponding to the number of discharges divided by the number of involuntary psychiatric hospitalizations) for each year. Then, we examined the reason of discharge for each measure. RESULTS: One hundred and forty-seven discharges were analyzed: 73 in the psychiatric forensic unit and 73 in the community psychiatric unit. Rates of discharges were 6.7% and 8.8% for the forensic unit and the general psychiatric unit, respectively. Several reasons for the discharges were common for the two units (failure to inform the patient, lack of physical examination), but others were specific to the forensic unit, such as the impossibility for the patients to communicate with their lawyer, or the lack of immediate dangerousness for the person or for the others. CONCLUSION: This study highlights the specific aspects of involuntary psychiatric hospitalizations for people in prison in France. Future studies are needed to assess the impact of these judge-ordered discharge on patient's mental health, particularly for incarcerated patients.

Efficacy of electromagnetic extracorporeal shockwave lithotripsy on high-density ureteral stones.

INTRODUCTION: Our aim was to evaluate electromagnetic extracorporeal shockwave lithotripsy (SWL) in treating high-density radiopaque ureteral stones on non-contrast computed tomography (NCCT). PATIENTS AND METHODS: Adult patients with radiopaque stones in the ureter who underwent SWL in a high volume center between 2016 and 2017 were retrospectively included. NCCT characteristics such as mean stone density (MSD), stone size, skin to stone distance (SSD) were recorded before treatment. Treatment success was defined as complete stone clearance (SF). RESULTS: 108 patients were included. Global stones MSD was 1119 HU. 55% and 62% of patients were SF respectively after 1 and 2 sessions of SWL. There was no difference of success rates between the treatment of low MSD (<1000 HU, n=33) and high MSD (≥1000 HU, n=75) (P=0.57, OR=0.79, 95% CI [0.35-1.80]). The SF rate dropped to 31.6% for 19 patients with ureteral stenting before treatment (P=0.02, OR=3.34, 95% CI [1.16-9.62]). Mean stone size was 7.2mm, SF rate for stones over 7mm were statistically lower (P=0.04, OR=2.18, 95% CI [1.00-4.73]). 4 patients needed ureteral stenting in emergency after SWL (3.7%). DISCUSSION: Electromagnetic SWL is a safe and effective way to treat ureteral stones. A high-density stone on NCCT may not be detrimental. Many parameters should be involved in the treatment decision such as stone size and ureteral stenting. LEVEL OF PROOF: 4.

[Caregivers' experiences with extreme prematurity]. / Vécu des soignants face à l'extrême prématurité.

Neonatal intensive care units receive very immature premature newborns. Mortality and morbidity rates remain high in this particularly fragile population. Caregivers involved with the child and his or her parents may experience moral distress. There are few studies on the experience of caregivers in these situations. Training, service architecture and sharing of experiences with specifically trained psychologists can improve this experience in these highly technical services.

[Social care for patients hospitalized in units for difficult patients]. / Accompagnement social des patients hospitalisés en unité pour malades difficiles.

The units for difficult patients are secure psychiatric wards that receive people suffering from mental illnesses with a risk of dangerous behaviour. Within the framework of the global care of these patients, the intervention of social service assistants plays an essential role. The objective is to induce the psychosocial benefits necessary for the stabilization and evolution of these patients.

[The Bomoko workshop in a day hospital for obese adolescents]. / L'atelier Bomoko en hôpital de jour pour adolescents obèses.

The Bomoko workshop of the Maison de Solenn-Maison des adolescents of the Cochin hospital is aimed at obese adolescents who are treated at the day hospital during a therapeutic education day. It was born from the common and multidisciplinary desire of a team to propose an innovative device combining psychomotricity and Photolanguage® to encourage the connection between body sensations, emotions and thoughts. Thanks to the time of body mediation, the work of expression and psychic elaboration is facilitated during the Photolanguage®.

[Child psychiatry in pediatric intensive care unit]. / Pédopsychiatrie en unité de soins intensifs pédiatriques.

A study was conducted in the pediatric intensive care and resuscitation unit of the Nice pediatric hospitals, University Hospital Center Lenval (06) from January to March 2015. Its objective was to describe the events and child psychiatric interventions experienced by young patients. Of the 181 individuals managed during the research, 63 met the inclusion criteria.

[Patient safety culture in neonatal intensive care units as seen by nurses]. / La culture de sécurité des patients dans les unités de soins intensifsnéonatals vue par les équipes.

Neonatal intensive care units (NICUs) are critical environments in terms of safety of care, with a high risk of adverse events. Measuring the patient safety culture of the professionals working there should help to improve the care offered. A descriptive cross-sectional study, conducted among 141 nurses and childcare workers in 2020 in 5 Tunisian hospitals, examined this question.

The effects of thymoquinone on memory impairment and inflammation in rats with hepatic encephalopathy induced by thioacetamide.

Hepatic encephalopathy (HE) is a prevalent complication of the central nervous system (CNS) that is caused by acute or chronic liver failure. This study was designed to evaluate the effects of thymoquinone (TQ) on thioacetamide (TAA)-induced HE in rats, and determine the consequential behavioral, biochemical, and histological changes. HE was induced in male Wistar rats by intraperitoneal (i.p.) injection of 200 mg/kg TAA once every 48 h for 14 consecutive days. Control groups received the normal saline containing 5 % DMSO. Thymoquinone (5, 10, and 20 mg/kg) was administered for ten consecutive days intraperitoneally (i.p.) after HE induction and it was continued until the end of the tests. Then, the passive avoidance memory, extracellular single unit, BBB permeability, and brain water content were evaluated. Moreover, hippocampal tissues were used for evaluation of oxidative stress index, inflammatory biomarkers, and histological parameters following HE. As result of the treatment, TQ improved passive avoidance memory, increased the average number of simultaneous firing of spikes/bins, improved the integrity of BBB, and decreased brain water content in the animal model of HE. Furthermore, the results indicated that treatment with TQ decreased the levels of inflammatory cytokines (TNF-α and IL-1ß) but increased the levels of glutathione (GSH) and anti-inflammatory cytokine (IL-10) of the surviving cells in the hippocampal tissues. This study demonstrates that TQ may have beneficial therapeutic effects on cognitive, oxidative stress, neuroinflammatory, and histological complications of HE in rat.

[Context, issues and perspectives of nutrition in hospitals]. / Contexte, enjeux et perspectives de la nutrition à l'hôpital.

Undernutrition is common in hospitals, and it worsens the vital and functional prognosis of patients. The earlier it is treated, the more effective it is. The prevention, detection, treatment and monitoring of undernutrition or the risk of undernutrition are a public health priority, which directly involves all carers. Management can be improved by their daily collaboration with a transversal nutrition unit.

The Neurological Study Unit: "A Combined Attack on a Single Problem from Many Angles".

In the 1920s, neurology was a fledgling discipline. Various attempts were made to establish programs relating to neurological care and research. One such initiative was the Neurological Study Unit (NSU) at the Yale School of Medicine. My aim is to chronicle the early years of the NSU (1924-40): the motivations for establishing the unit, its structure, its challenges, and its evolution. I have studied all documents related to the NSU at Manuscripts & Archives, Yale University Library. The NSU was heralded as a "combined attack on a single problem from many angles." It was slow to develop, however, and had a number of missing elements. While some of this may have been due to a lack of funds and the absence of a dedicated neurologist, it was also the result of a failure to conceptualize a neurological unit, the slow evolution-into-existence of a nascent and fledgling medical discipline, growing pains and frictions within the leadership, a university-based rather than a hospital-based model of operation, and turf wars between neurology and allied disciplines.

[Nutrition and nursing]. / Nutrition et soins infirmiers.

Nutritional nursing care, whether prescribed or on its own role, is a fundamental aspect of the fight against undernutrition in hospital, which is a determinant of vital and functional prognosis. This care includes screening for undernutrition and its risk factors, assessment of intake and feeding difficulties, enrichment of oral nutrition, enteral and parenteral nutrition. Given the complexity and importance of these tasks, a multi-professional approach involving a transverse nutrition unit is beneficial.