RESUMO
Autism spectrum disorders (ASD) are neurodevelopmental disorders of varying intensity and disability. The reference health strategy in France for the care of young children with autism is day care hospital (DCH). As the number of places in DCH is insufficient, medically coordinated care programs by the mental health consultation centers (MHCC) are being developed in response. OBJECTIVES: Our objective is to evaluate the effectiveness of a medically coordinated care program in a MHCC versus the care in DCH of child psychiatry. METHODS: Non-inferiority retrospective study comparing the evolution after one year of care of 20 ASD children divided into two groups DCH and MHCC. In the DCH ASD group, the child is taken care of two half-days a week in a day hospital with individual educational care. In the MHCC ASD group, the child benefits from a medically coordinated care program. The medical care is reinforced by more frequent and longer consultations with guidance offered to parents. In both groups, the child receives speech therapy and psychomotor therapy in private practice at the same rate. Comparison is made using a composite criterion associating CARS-2 and VABS-II. Non-inferiority of the medically coordinated care program in autism in reference to DCH was tested on the difference between the changes (DCH group variation - MHCC group variation) with a non-inferiority threshold of 10% of the initial value of each score. RESULTS: We observed a reduction in autism severity at the CARS-2 and a moderate improvement in socio-adaptive behavior at the VABS-II in both groups. This trend was even more pronounced in the MHCC group than in the DCH group, but only the greater reduction in CARS-2 severity in the MHCC was statistically significant. CONCLUSIONS: As it is necessary to integrate the two scales into the composite criterion, it is not possible to retain the non-inferiority of the MHCC with care program. However, both those children followed in DCH and those in the MHCC care program progress. This shows the relevance of the care offered at the MHCC for children suffering from ASD, in the context of a growing lack of space in DCH. The continuation of this research work through multicenter studies with larger numbers could demonstrate the non-inferiority of coordinated care programs in the MHCC versus DCH. It would also allow subgroups to be set up, taking into account the initial characteristics of the children in order to have more precise indications concerning the relevance of each treatment.
RESUMO
Anxiety about ageing, as well as old age, is rooted in public discourse and has a negative impact on the quality of the relationship with the elderly, particularly in the context of care relationships with more vulnerable seniors. This text proposes a theoretical and empirical reflection on ageism, manifested as much in its hostile as in its compassionate forms.
Assuntos
Etarismo , Humanos , Etarismo/psicologia , Idoso , Relações Enfermeiro-Paciente , Envelhecimento/psicologiaRESUMO
The ageing of Western societies is leading to a marked increase in mortality. Death and old age are now intertwined. This situation should be of particular concern to palliative care. But in reality, palliative care remains too inaccessible to the oldest sections of the population. Why this paradox? After reviewing the clinical and organisational reasons that are often given, we invite you to take a more global look, one that is both sociological and ethical.
Assuntos
Cuidados Paliativos , Populações Vulneráveis , Humanos , Cuidados Paliativos/ética , Idoso , Serviços de Saúde para Idosos/ética , Idoso de 80 Anos ou maisRESUMO
Hospitalization is an important stage in the life of the elderly. All too often, this experience is accompanied by both physical and psychological decline. Based on self-determination theory, the aim was to qualitatively characterize support for self-determination in follow-up care and rehabilitation services (behaviours and attitudes of healthcare professionals, and patients' perception of them).
Assuntos
Autonomia Pessoal , Humanos , Idoso , Masculino , Feminino , Apoio Social , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , HospitalizaçãoRESUMO
The multi-professional nature of the traditional psychiatric team is not enough to create its therapeutic function. The latter depends on sharing the same care objectives, the same way of working together and the organization of work. Knowledge of each person's professional skills and respect for their own scope of action are essential. Interdisciplinarity articulates skills in collective thinking along two axes: clinical and institutional.
Assuntos
Comportamento Cooperativo , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente , Enfermagem Psiquiátrica , Humanos , Equipe de Assistência ao Paciente/organização & administração , Enfermagem Psiquiátrica/organização & administração , França , Colaboração Intersetorial , Transtornos Mentais/enfermagem , Transtornos Mentais/terapia , Competência ClínicaRESUMO
The prevalence of management concerns in hospitals and a highly normative conception of health care are converging today in a standardization of care. The latter is undoubtedly at the root of the current malaise among caregivers. Indeed, the New Public Management approach is encouraging them, despite themselves, to carry out their missions to the detriment of the values of care. A more appropriate form of management would, on the contrary, be based on a continuity to be sought between care values and management values, around the notion of support. This would mean reinstating concern for interpersonal relationships at the heart of care management missions.
Assuntos
Atenção à Saúde , Hospitais , HumanosRESUMO
This analysis of the ethical issues raised by the relationship between caregiver and patient is based on the history of psychiatry and sensitivity to the ethical tensions that run through the field of psychiatry and mental health. Taking a step back from the injunction to treat well, not fetishizing it, adopting a holistic approach, equipping ourselves to counter the stigmatization and self-stigmatization that so often accompany psychic and/or psychosocial disability, and inviting reflection on proportionality in mental health are all ethical priorities that are insufficiently invested in psychiatric clinics.
Assuntos
Transtornos Mentais , Psiquiatria , Humanos , Transtornos Mentais/terapia , Psicoterapia , Saúde MentalRESUMO
At a medical-psychological center, a therapeutic program based on relaxation and mindfulness meditation sessions is offered to people suffering from chronic insomnia referred by the center's psychiatrists, psychologists and advanced practice nurse. This treatment, which can be complementary to ongoing medication, is an alternative to pharmacological approaches.
Assuntos
Meditação , Atenção Plena , Terapia de Relaxamento , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/terapia , Distúrbios do Início e da Manutenção do Sono/enfermagem , Terapia Combinada , Comunicação Interdisciplinar , Colaboração IntersetorialRESUMO
A teacher of adapted physical activity and health (EAPAS) is a paramedical professional. A professional degree in sciences and techniques of physical and sports activities, with a specialization in adapted physical activity and health, is a prerequisite for this profession. These studies can be supplemented by a professional master's degree. EAPAS practitioners can work in the medico-social, somatic, psychiatric, geriatric and functional rehabilitation sectors. In mental health, they work as part of multi-disciplinary teams, with institutional support. They act on medical prescription to achieve psychological, physical, motivational and social benefits.
Assuntos
Currículo , Transtornos Mentais , Humanos , França , Transtornos Mentais/psicologia , Transtornos Mentais/enfermagem , Transtornos Mentais/reabilitação , Comunicação Interdisciplinar , Exercício Físico/psicologia , Colaboração Intersetorial , Enfermagem Psiquiátrica/educação , Equipe de Assistência ao Paciente , Promoção da SaúdeRESUMO
Cooperation protocols enable healthcare professionals to work together to meet patients' needs. One of the challenges of these protocols is to offer a wider range of care by reducing the time taken to access care, while also optimising the patient's pathway. Four cooperation protocols have been validated for emergency services.
Assuntos
Protocolos Clínicos , Serviço Hospitalar de Emergência , Humanos , Serviço Hospitalar de Emergência/organização & administração , Protocolos Clínicos/normas , Comportamento Cooperativo , Equipe de Assistência ao Paciente/organização & administraçãoRESUMO
Transforming healthcare provision to better meet healthcare needs and ensure continuity of care requires the development of coordinated practice. Whether it's a multi-professional health center (MSP), a primary care team (ESP), a territorial professional health community (CPTS) or a health center (CDS), whatever the way it's organized, this type of practice enables the coordination of the various professionals involved in primary care.
Assuntos
Atenção Primária à Saúde , Humanos , Atenção Primária à Saúde/organização & administração , França , Equipe de Assistência ao Paciente/organização & administração , Saúde PúblicaRESUMO
A nurse graduating in 2018, Noémie's guiding principle has always been her desire to discover IDE practice outside our borders. To this end, once she had her diploma in hand, and in parallel with her nursing practice in her native Isère region, she enriched her knowledge by taking a university diploma (DU) in "international solidarity action in humanitarian health". When she obtained her diploma, she decided to settle in French Polynesia, a French territory at the end of the world. Here, she shares her experiences as a nurse in an isolated island environment, highlighting the added value of this experience.
Assuntos
Altruísmo , Enfermagem , Feminino , Humanos , Polinésia , IlhasRESUMO
Nursing students from a nursing training institute (Ifsi) in Seine-Saint-Denis, we had the opportunity to experience an intercultural internship in Africa. It is this experience that we wish to convey through this article, by highlighting the cultural encounter and the richness of the various existing relationships, shared through this unique experience.
Assuntos
Educação em Enfermagem , Internato e Residência , Estudantes de Enfermagem , Humanos , África , Assistência ao PacienteRESUMO
The role of advanced practice nursing in France is still in its definition phase. While the prefiguration of the model was mainly in primary care, notably through the activities of the Asalée association, the first university graduates are mainly future hospital professionals, with a specialized orientation. Whether working in general or organ medicine, the advanced practice nurse (APN) is committed to making the patient's care experience more fluid, as part of a multi-professional team. Thanks to the acquisition of new skills and a structuring legal framework, collaboration between doctors and APNs is becoming a lace-making process, to best meet local needs.
Assuntos
Prática Avançada de Enfermagem , Humanos , Prática Avançada de Enfermagem/organização & administração , França , Comportamento Cooperativo , Relações Médico-Enfermeiro , Equipe de Assistência ao Paciente/organização & administraçãoRESUMO
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.
Assuntos
Unidades Móveis de Saúde , Humanos , França , Unidades Móveis de Saúde/organização & administração , Relações Pais-Filho , Recém-Nascido , Gravidez , Lactente , FemininoRESUMO
In 2023, the "Amae" mobile perinatal early intervention team in the child psychiatry department of the Pitié-Salpêtrière hospital followed 49 families for almost 412 home visits. The coexistence of biopsychosocial vulnerability factors was the rule. Generally requested by maternity hospitals (45% in antenatal care), the team offers care focused on parent-child bonds during visits at home, and facilitates the articulation of the different fields involved in contexts at high risk of care breakdown.
Assuntos
Assistência Perinatal , Humanos , Feminino , Gravidez , Unidades Móveis de Saúde , Recém-Nascido , Equipe de Assistência ao Paciente , Intervenção Médica PrecoceRESUMO
The complexity and specificity of joint care in perinatal psychiatry call for a rethinking of gentleness. Allowing oneself to make it the object of reflection in its own right means summoning up an essential dimension of welcoming, carrying and meeting the other, which are at the heart of support. Articulating adversity and fragility, creativity and destructiveness, gentleness is a quality, a texture on which a care team can rely from both a clinical and an institutional point of view.
Assuntos
Assistência Perinatal , Humanos , Feminino , Gravidez , EmpatiaRESUMO
The parent-baby unit at the Jean-Verdier hospital in Seine-Saint-Denis offers outpatient and mobile care. Migrant families in extremely precarious situations, often with traumatic histories, are met. Home visits facilitate access and continuity of care. Nonetheless, this work and the broader context in which it is carried out have an impact on the therapists' experience and care methods. This makes it all the more essential to have a co-therapy system in place, to take primary needs into account and to support mothering care in therapeutic work.
Assuntos
Serviços de Assistência Domiciliar , Humanos , Feminino , Recém-Nascido , Gravidez , Assistência Perinatal , FrançaRESUMO
Skin-to-skin relaxation is offered by one of the department's psychomotor therapists, within a precise framework of clearly defined indications and contraindications. The aim of this intervention modality is to support the parent-baby relationship in a context of vulnerability. A self-questionnaire for parents was used to take stock of the practice of skin-to-skin relaxation at the Centre Hospitalier Intercommunal de Créteil. The use of this mediation appears beneficial and deserves to be developed in neonatology.
Assuntos
Método Canguru , Humanos , Recém-Nascido , Método Canguru/psicologia , Método Canguru/métodos , Unidades de Terapia Intensiva Neonatal , Relações Pais-FilhoRESUMO
In neonatology and pediatric intensive care units, as in pediatric units, development support care practiced according to the approach of psychologist André Bullinger takes into account sensorimotor and psychological aspects. Considering the quality and quantity of movements, from the antenatal period, allows for individualized and early care. Sensitive periods of sensorimotor development, during which brain plasticity is optimal, are decisive for psychomotor and cognitive development. Observation and evaluation of movements, as well as postural support to enable active motor skills, constitute essential elements of the developmental support provided to vulnerable children of all ages.