Anorexia nervosa: Enhancing motivation to change with self-determination theory.

Motivational deficits (little or no motivation to change) are often reported in patients with eating disorders, particularly anorexia nervosa. The motivational approaches frequently used by French clinicians rely solely on a dichotomous view of motivation (intrinsic vs. extrinsic). In self-determination theory, certain forms of extrinsic motivation can strengthen an individual's commitment to an activity, providing they are self-determined. This theory therefore extends and enriches the dual motivational approach by highlighting potentially useful forms of extrinsic motivation and by emphasizing the importance of behavioral regulation. Empirical work is now needed to assess how clinicians can use self-determination theory to enhance motivation to change among patients with anorexia nervosa and encourage their adherence to care management plans.

Is intimate partner sexual violence a singular violence?

OBJECTIVE: This study aims to examine the specificities of intimate partner sexual violence among heterosexual partners, as well as to contrast them to the sexual violence perpetrated by strangers or acquaintances. METHOD: A narrative review was conducted to identify relevant findings in the scientific and medical literature to inform about intimate partner sexual violence. Findings were also analysed with the lens of the clinical experience of the authors working with men convicted of intimate partner sexual violence. RESULTS: Intimate partner sexual violence was legally recognized by article 222-22 of the French Penal Code in 2006. In France rape committed by intimate partners accounts for 34% of rapes of adult women. Intimate partner sexual violence is likely to be underestimated due to variables of individual, relationship, community, and societal levels. Despite a common perception that intimate partner sexual violence is located at the lower end of the severity continuum compared with other forms of sexual violence, studies have shown that intimate sexual violence is as or even more harmful to a woman. Compared to victims of other types of sexual violence, women sexually abused by an intimate partner experience more severe mental health outcomes such as depression, anxiety, anger, self-blame, increased feelings of shame, post-traumatic stress disorder, substance abuse to cope or suicide attempt. Intimate partner sexual violence is also associated with humiliation and betrayal of trust, greater physical violence, greater risk of sexually transmitted infections, re-victimization, higher risk of serious injury or homicide. Beyond the legal definition of sexual rape, intimate partner sexual violence encompasses a wide range of subtle and complex behaviors such as coercive tactics, blackmail, implicit threat or reproductive control. The COVID-19 pandemic lockdown seems to have played a "revealing" or "aggravating" role rather than a "triggering" of intimate violence. The treatment of intimate partner sexual violence is complex and should consider diverse therapeutic strategies to deconstruct the offenders' societal misrepresentations and to make them aware of their partner's inter-subjectivity. CONCLUSIONS: Identifying and understanding intimate partner sexual violence need to be improved both to refine the treatment of the offender-victim dyad and to break down the toxic relational dynamics maintaining abusive behaviors.

[Refusal of care by the elderly]. / Le refus de soins en gériatrie.

Refusal of care is a frequent occurrence in geriatric medicine, especially among people with neurocognitive diseases, particularly in the advanced stages. These refusals of care are a daily burden, not only for the patients themselves, but also for their carers and caregivers. Although they can be prevented, the absence of a single, simple strategy for overcoming them is a real challenge for professionals and carers alike. Their management calls for an approach that is essentially non-pharmacological, always interdisciplinary, humanistic and ethically grounded.

[Outpatient care at Desgenettes: tailor-made care for military personnel]. / Le dispositif ambulatoire à Desgenettes, des soins sur mesure pour les militaires.

In 2024, the Desgenettes military hospital was transformed into an outpatient facility. The psychiatry department has been reorganized into a multidisciplinary day-care center based on the consultation service. Patients are cared for on a case-by-case basis, based on a personalized care plan drawn up collectively. Care is based on the support of caregivers using a variety of methods. It is always adapted to the clinical situation, enabling us to respond to crisis situations. Care organization reflects a dynamic, constantly evolving process.

[Organization of the emergency operating room]. / L'organisation au bloc opératoire des urgences.

The structure and organization of operating theatres vary from one healthcare facility to another. Some establishments have a multi-disciplinary operating theatre, with shared operating theatres and staff, while others have separate operating theatres, often divided by discipline. Emergencies are therefore dealt with in the operating theatres for scheduled surgery. However, some university hospitals also have emergency operating theatres.

[Average prematurity: medical and developmental aspects]. / Prématurité moyenne : aspects médicaux et développementaux.

Children born with moderate prematurity are at increased risk of neonatal morbidity, rehospitalization during the first year, and subsequent medical and neurodevelopmental disorders. Care in a specialized environment, at best without separation of mother and child, is necessary. Early developmental support, particularly through skin-to-skin contact, breastfeeding and couplet care, is recommended.

[Welcoming severely traumatized patients]. / L'accueil du patient traumatisé grave.

Severe trauma accounts for around 15% of all traumas, but remains the leading cause of death in people under 45. The organization of networked care for severe trauma is becoming a necessity in France. Thanks to this kind of organization, it is possible to speed up the care of these patients, and optimize their referral to the most appropriate reception center. The Bicêtre University Hospital (CHU) is one of six trauma centers in the Île-de-France region, all working to the same specifications set out by the Île-de-France regional health agency.

[Emergency management of a young patient with ponytail syndrome]. / Prise en charge en urgence d'un patient jeune victime du syndrome de la queue-de-cheval.

A 31-year-old man was brought to the emergency department because, for the past two days, he had been experiencing paresthesia-like sensory disturbances in his lower limbs, with dorsal pain that was not relieved by analgesics, as well as the appearance of sphincter disturbances and increasing difficulty in mobilization due to balance disturbances and pain. Presentation of this clinical case.

[The role of the social worker in the orthopedics and traumatology department]. / Le rôle de l'assistant social en service d'orthopédie et traumatologie.

Trauma patients often lose their autonomy in the aftermath of an accident. This handicap adds to the burden of other social problems that pre-existed the trauma. The social worker's role with these patients is therefore essential.

[Follow-up of cerebral palsy patients in neurological rehabilitation departments]. / Le suivi des patients cérébrolésés en service de rééducation neurologique.

Patients suffering from head trauma or hemorrhagic cardiovascular accident can be cared for in special facilities. Located near Grenoble, the Fondation santé des étudiants de France Grenoble La Tronche (ex-clinique du Grésivaudan) (38) provides post-resuscitation care for brain-damaged patients. This article presents the department, its specific features and their daily routine, as shared with us by Mélanie, Leslie and her fellow nurses in the neurological rehabilitation department.

[Systematic investigation of surgical site infections (SSI) in plastic reconstructive and aesthetic surgery (ERCS): Feedback]. / Investigation systématique des infections de site opératoire (ISO) en chirurgie plastique reconstructrice et esthétique (CPRE) : retour d'expérience.

Surgical site infection (SSI) in plastic, reconstructive and aesthetic surgery (ERCP) is quite uncommon compared to other surgical specialities but remains one of the main complications. The aim of our study was to provide feedback on the systematic investigation of SSI in ERCP. This is a monocentric retrospective study, including all paediatric and adult patients who have undergone ERCP surgery between 01/01/2014 and 31/12/2021. During this period, the department systematically investigated all SSI cases. Eight thousand eight hundred and seventy-eight surgical procedures were performed. The SSI rate was 0.34%. Thirty SSIs (19W,11M), with a mean age of 56 years (none paediatric), were investigated. Twenty-seven patients suffered from comorbidities. The surgical indications included 17 cases of skin cancer, 7 cases of weight loss, 4 cases of breast reconstruction, 1 lipoma, 1 pectus excavatum. Eleven surgeries consisted in lymphnode procedures (8 sentinel lymphnodes, 3 curage). The average operating time was 116minutes. Nineteen patients received antibiotic prophylaxis. The average time to onset of SSI after surgery was 10 days. The most prevalent bacteria were commensals of the skin flora and the digestive tract. Apart from surgical management, 100% of patients were treated with antibiotics. High age, multiple comorbidities, long, combined procedures, placement of equipment, lymph node surgery, post-operative punctures on implanted equipment, are all risks factors for SSI. The implementation of a systematic monitoring of SSI within our department has provided us with the opportunity to analyse our data in real time and allow us to adjust our practices if necessary. This process can be used in other plastic reconstructive and aesthetic surgery departments. The collection and analysis of SSIs is both easily done and the procedure is well standardized. The assistance of the operational hygiene team is a key asset for the success of this project. The development of this type of procedure on a national level could be an asset to improve the management of SSI by taking advantage of the experience of a larger number of centres.

Potential drug-drug interactions in patients presenting with osteoarthritis to community orthopaedic clinics of Abbottabad, Khyber Pakhtunkhwa: A cross-sectional study.

OBJECTIVES: Osteoarthritis (OA) causes long-term pain and disorders of lower extremities. Paracetamol is the drug of choice; however, NSAIDs, opioids and steroids are frequently employed in the symptomatic relief of OA. The prescribing of multiple analgesics leads to potential drug-drug interactions (pDDIs). The primary objective of this study was to identify the prevalence and predictors of pDDIs in OA. MATERIALS AND METHODS: A total of three hundred and eighty-six patients, either newly diagnosed or with a history of OA, were enrolled for this cross-sectional study. Data regarding patients' demographics, clinical characteristics and prescribed medications were recorded from the prescriptions and examined for the pDDIs using Medscape multidrug interaction checker. RESULTS: Among 386, most patients were females (53.4%). The most prevalent diagnoses were knee OA (39.7%) and unspecified OA (31.3%). Paracetamol and topical NSAIDs were underprescribed whereas an oral NSAID, Diclofenac, was the most frequently used drug in OA. Total of 109 pDDIs were found in 386 prescriptions, of which 63.3% DDIs were categorised as moderate, followed by minor (34.9%) and major (1.8%). CONCLUSIONS: This study finds a prevalence of DDIs and polypharmacy among the OA patients. Collaborative efforts among healthcare providers, pharmacists, and patients themselves are essential to optimize medication regimens and minimize the polypharmacy including the associated risks as well as DDIs.

[Presbyphagia and swallowing disorders]. / Presbyphagie et troubles de la déglutition.

Swallowing disorders, which are frequent in geriatrics, are linked to multiple pathologies: cancer, stroke, neurocognitive disorders, acute confusion, vigilance disorders, etc. They can have serious consequences and therefore require special care. From the identification of the disorders by the doctor, the nurse, the caregiver, to the speech therapy assessment, through the adaptation of the diet by the dietician, the management of swallowing disorders concerns all the medical and paramedical staff. The aim of this article is to present the main existing recommendations to promote the patient's feeding despite the presence of these disorders.

[Contribution of equine therapy in the management of post-traumatic stress disorder]. / Apport de la thérapie équine dans la prise en charge du trouble de stress post-traumatique.

For several years, animal-mediated therapies have been used in the treatment of psychiatric patients. Post-traumatic stress disorder has the particularity of being generated by an external event in a person a priori free of mental pathology. In this disorder, various so-called targeted psychotherapies have proven to be effective, including equine therapy.

[The experience of pain: cultural representations to give meaning]. / L'expérience de la douleur : les représentations culturelles pour donner du sens.

The pain center of the Armand-Trousseau hospital in Paris receives children and adolescents for a multidisciplinary management of their pain. From all cultural backgrounds, these young people have different representations of suffering. The aim here is not to highlight cultural differences in the sensory experience of pain, but to analyze the representations of the experience of chronic pain. To do this, we will use the clinical case of Kayla, aged 15.

[Taking care of an unaccompanied minor's body at the Maison des adolescents]. / Prendre en charge le corps et son histoire, parcours d'une mineure non accompagnée à la Maison des adolescents.

The care of unaccompanied young exiles in public health care facilities for adolescents often requires teams to adapt their capacities for institutional containment. We describe the case of a 16 year old female migrant adolescent, whose follow-up occurred at the Maison des adolescents of the Cochin Hospital, with several healthcare workers involved. The healthcare team had to reflect on the meaning of her somatic symptoms and why the referring adults were so worried (such as fear of death). We describe how we articulated somatic and psychological care for this adolescent girl living in a precarious situation.

[From social medicine to the management of precariousness in health]. / De la médecine sociale à la prise en charge de la précarité en santé.

A review of the history leading from the creation of social medicine to the management of precariousness in the health field. We will define the main concepts (precariousness, poverty, social inequalities in health) and indicate the main barriers to access to care for people in precarious situations. Finally, we will give some guidelines for the healthcare community in order to improve care.

[Accompanying teams to decipher and manage emotions in certain care situations]. / Accompagner les équipes pour décrypter et gérer les émotions dans certaines situations de soins.

Caring for others means being confronted with situations that arouse emotions. To provide the right care, the caregiver must be able to manage them, whether they are positive or negative. To support caregivers, the health executive plays a fundamental role and must be able to propose actions to facilitate the management of emotions within the team as well as towards patients and their relatives.

[Recognizing acute confusional syndrome and neurocognitive disorders in the emergency department]. / Reconnaître un syndrome confusionnel aigu et des troubles neurocognitifs aux urgences.

In the heart of the emergency room, when the nurse takes charge of the patient, he/she must be able to distinguish between an acute confusional syndrome and psychobehavioral symptoms related to neurocognitive disorders. Indeed, early identification of the confusional syndrome is essential to accelerate the implementation of non-drug measures by the nurse in order to reduce its duration and the induced complications.

[Supporting families in the management of gastroesophageal reflux disease in children]. / Accompagner les familles dans la prise en soin du reflux gastro-œsophagien pathologique chez l'enfant.

Gastroesophageal reflux disease (GERD) in children is a frequent reason for medical consultation. It is defined as the involuntary passage of gastric contents into the esophagus, with or without regurgitation and vomiting. It can become pathological if it leads to embarrassing symptoms and complications. Often confronted with this pathology, nursery nurses sometimes find themselves at a loss when it comes to treating the symptoms of pathological GERD in a toddler, as well as in supporting the parents. In order to give them some ideas, a review of the literature on the benefits of non-medicinal strategies on regurgitation in full-term infants with pathological GERD was conducted.