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Abstract: Objective: Mindfulness-based cognitive interventions are increasingly making their way into the field of healthcare on account of proven effects in a wide range of mental disorders. Despite the psychological aspect emphazised in the etiology of sexual disorders, they paradoxically have been less investigated in terms of sexual problem management. The objective of this paper will be to highlight through the review of studies relating to the integration of mindfulness in sexotherapeutic programs the applicability potential of these approaches and, more particularly, to examine the specific relevance of Mindfulness-Based Cognitive Therapy (MBCT). Method: To show the interest of mindfulness for sexual problems, which is the major component of the MBCT intervention, we have first reviewed the underlying psychological causes of sexual dysfunctions through the DSM-4TR criteria and the main international search engines Interscience Wiley, PsycARTICLES, PubMed, Science Direct and Springerlink. Moreover, this bibliographic review has enabled us to select the studies relating to the use of mindfulness in the field of sexology. Results: This research has enabled to show four main types of etiological factors of psychological type, namely cognitive, emotional, behavioural and environmental factors. The scientific literature points out more specifically the key role of cognitive parameters in sexuality, especially through the influence of negative automatic thoughts and distractions, and of relational parameters such as a bad communication in the couple. Furthermore, it reveals a paucity of empirical studies and two main orientations targeted respectively on the relevance of mindfulness to sexual or relational problems, as well as, to our knowledge, no study about MBCT in that research field. Discussion: Considering the action process of the multimodal MBCT program detailed in this paper, the highlighting of the obvious link between cognitive factors and sexual dysfunctions and the promising results of the studies integrating mindfulness in sexotherapeutic treatment, this new kind of approach seems to be of great interest for the management of sexual dysfunctions and, more specifically, through the relapse prevention which is a fundamental aspect of any sexual therapy. [Copyright &y& Elsevier]

Abstract: The health record in its paper version is a success as a device of interprofessional communication around the child. It made it possible to outline a true "culture of sharing". But it presents limits, which principal ones are a bad control of its confidentiality, a defect of ubiquity, a lack of interactivity and evolution capacities. Its computerization in a standardized architecture will make it possible to go through these limits, making of the child''s health notebook a powerful tool for a better communication, sharing informations and the medical follow-up of the child. All the actors of the child''s health will be easily able to reach informations that they try, today, to share with more or less success. So defined, the child''s electronic health record, the heir of the paper version, should find all its place as personal medical record using the same infrastructures and the same developments as the adult one. [Copyright &y& Elsevier]

The paper presents a two-year follow-up of the patients admitted in 1999 in three catchment areas (sectors). By comparing the group of patients who were new in 1999 (N = 321) to the group of those who were already treated (N = 498), the paper describes the type of care received by the patients in 1999, 2000 and 2001 according to age, gender, diagnosis, and type of care. The paper describes the probability of follow up according to the above data. The paper shows the value of a knowledge of the actual pathways of the patients within the psychiatric care organization. [Copyright &y& Elsevier]

Abstract: Objectives: Telemedicine grows differently among the different specialties. Tele-psychiatry, one of the earliest applications of telemedicine, is struggling to find its full place in patient care, and is often seen only as a geographical distances stopgap. The main objective of this paper is to summarize the stakes of this new practice and to put some answers to the question of its place in our current practices. Materials and methods: Literature review focused on patient satisfaction and comparison with the practice of face-to-face. Review of international recommendations on the practice of tele-psychiatry. Reminder of its ethical, professional and legal framework in France. Results: The use of video-consultation appears to improve access to care, may serve to promote patient education, to avoid unnecessary travel to the patient or therapist. Patient satisfaction appears identical to the face-to-face practice. Conclusions: Tele-psychiatry, used and disclosed appropriately, can greatly contribute to improve care in numerous fields: consultation-liaison psychiatry, accessibility to overspecialised consultations, continuing education of physicians. [Copyright &y& Elsevier]

Abstract: Objective: To estimate the morbidity and mortality conferences (MMC) impact in intensive care unit (ICU) setting on quality of care and patients’ safety. Data sources: A review of English and French articles in Medline database (1990–2011) related to MMC in the ICU. Keywords used: “morbidity (and) mortality conference(s)”, “intensive care unit”, “intensive/critical care medicine”. Additional studies identified by hand search in French national guidelines about MMCs and in the Annales Françaises d’Anesthésie Réanimation and Réanimation journals index. Identification and preliminary analysis performed using title and abstract, for every study related to MMC in the ICU. Study selection: Only original studies about MMC in the ICU setting that reported an assessment were included. Papers reporting guidelines and methods for MMC implementation were excluded. Data extraction: Extraction used predefined data fields, including study design, MMC characteristics, assessment methods and results. Data synthesis: Studies about MMC in the ICU are recent and scarce. Results comparison and synthesis are impaired by discrepancies in study designs. Although the effectiveness of MMC is not evidence-based, data are consistent for their positive impact on quality of care and patient safety in the ICU. Conclusion: Further studies are required to assess the impact of MMC in the ICU. Based on this literature review, a 4-level evaluation scheme can be suggested: 1) evaluation of MMC implementation in care units and facilities; 2) evaluation of MMC organization; 3) evaluation of MMC on quality of care; 4) evaluation of MMC impact on patients’ mortality and morbidity. [Copyright &y& Elsevier]

Abstract: Introduction: In the case of multidigital hand trauma, the tissue of the amputated parts can be used for the reconstruction of the defected tissue localized on the other fingers. Patients and methods: A series of seven patients has been reviewed in this paper; the authors illustrate the different possibilities of using the “spare-parts concept” in the emergency hand trauma surgery. Results: The functional results are presented. Discussion: The different techniques of reconstruction using the “spare-parts concept” are discussed. Conclusion: In the cases of multidigital lesions, the surgeon should choose the best opportunity to use the tissue of the amputated digits, or the non-conservable ones, to reconstruct the neighboring preserved segments. [Copyright &y& Elsevier]

Abstract: Bacground: Stenotrophomonas maltophilia (Smalto) is a prominent nosocomial pathogen, commonly isolated in the hospital environment. Multiple Smalto nosocomial outbreaks have been linked to contaminated water sources. This study aimed to develop a medium able to ease healthcare environment Smalto isolation. Methods: Financed, from March 2007 to June 2008, by a university hospital of Amiens’ clinical research program, this study allowed Stenotrophomonas maltophilia selective medium with coloured indicator (SM2i) development. SM2i is constituted of Mueller Hinton agar (MH), maltose, DL-methionine, bromothymol blue. The mixture sterilized is refreshed at 50°C, its pH adjusted to 7.1, and render selective by addition of vancomycin, imipenem and amphotericin B. Then, SM2i agar is sunk into 90cm diameter Petri dish dated and stored at 4°C for 4 weeks. SM2i is developed using Pasteur Institute culture type collection (CIP) strains of Smalto, Burkholderia cepacia, Pseudomonas aeruginosa (Psa) and a Smalto strain of our hygiene laboratory collection. It was validate on Psa imipenem-resistant and Enterococcus faecium vancomycin-resistant strains, then, tested on cold water first jet and faucet cotton-swabs samples. SM2i tests were made in comparison with the MH agar, MH agar plus four paper disks loaded 10μg of imipenem and Cetrimed agar. Its sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, accuracy, likehood-ratio (LR) and Youden index have been determined. Results: SM2i agar is better in culturing Smalto test-strains. On SM2i, Smalto colonies are smooth, round, greeny, olive or lime green, have a green olive centre with a peripheral lighter or a dark green centre with an olive green suburb surrounded by a blue halo. SM2i is a selective, specific, predictive, accurate medium to search for Smalto in healthcare environment. In 122 pairs of cold water first jet and taps cotton-swabs samples, Smalto was isolated from 14.8% of water samples, 10.7% of cotton-swabs samples. It was isolated alone in 6.6% of water samples and 2.5% of swab samples. Thus, smalto has biocontaminated 17.2% of cold water taps. Compared to MH agar, SM2i sensitivity, specificity, PPV, NPV, accuracy, LR were 100, 100, 100, 100, 100% and ∞, and 87.5, 100, 100, 98.1, 98.4% and ∞ for water and cotton-swabs samples respectively. Conclusion: SM2i is a selective, specific, predictive medium which can allow easily isolating and identifying accurately Smalto in environmental samples. Its evaluation on clinical samples is on going. [Copyright &y& Elsevier]

Abstract: The MEAH, a French national agency working on health services organization, has led a two-year campaign on safety improvement in radiotherapy centers. The pilot project involved three voluntary French cancer centers in 2005 and 2006. Building on the results of this project, a roll-out campaign has been launched, involving more than 50 additional cancer centers from 2007 and on. This paper presents the results of experiences of these campaigns. Notably, the axes of improvement chosen by professionals, such as risk analysis or use of checklists are discussed. [Copyright &y& Elsevier]

Abstract: Aim: The aim of this paper is to review our scientific knowledge of the effect of aerobic training on the activity of the autonomic nervous system on the cardiovascular function measured by short-term heart rate variability (HRV). Current knowledge: Cardiovascular morbidity and mortality are associated with autonomic nervous system disorders. Then, HRV represents prognosis tool of cardiovascular mortality. Aerobic training is a non-pharmacological process to increase cardiovascular health. Points of view and plans: Even if aerobic training improved HRV, cardiovascular autonomic adaptations seem to be dependant of various factors such as age, sex and training characteristics. To determine minimal quantity of physical activity to improve HRV and cardiovascular health, it is necessary to study the impact of these parameters. [Copyright &y& Elsevier]

Abstract: The management of the documentation is one of the key points regarding the efficacy and the performance of the quality management of health centres. It offers to all professionals the possibility to be informed on the procedures in use, leading to a pool of documents for improvement of organisations and for securing the critical steps of the patient management. In this paper, we will describe the optimal organisation of the documentation according to Haute autorité de santé (HAS) and ISO recommendations, then we will discuss in concrete terms the potential methods usable for the production of a tool well adapted to our routine practice, in order to achieve the objectives for security. [Copyright &y& Elsevier]

Abstract: Background: In May 1978, was voted Law 180, forbidding any new admission in Italian mental hospitals. Many authors set it as an example to be followed in other countries; others contradict this point of view. The purpose of this paper is to analyse the Italian psychiatric revolution in retrospect thirty years later. Method: Several articles and books written by stakeholders and by social researchers were reviewed. Results: The occurrence of the Italian psychiatric revolution cannot be understood without considering the backward situation of mental care in Italy at the time. Changes began before 1978 but were accelerated and shaped by the law. However, some flaws of the previous system have remained over time, most of all, the North-South gap. Discussion: Three points are specially original in Italy and need to be considered before advocating a similar law in another country: first, phasing out psychiatric hospitals went along with difficult problems, second in Italy, local human action is very important, so that implementation of such a law is a bottom-up process, and third, the history of the Italian mental care system has created in the general population a lower propensity to seek care than in other countries. [Copyright &y& Elsevier]

Abstract: This paper reviews the cognitive-behavioural strategies of psychotherapy applied to hypochondria. Cognitive mechanisms of hypochondria are the tendency to amplify body manifestations (pain, fatigue…) and to interpret them in a catastrophic manner. The persistence of anxiety is due to a confirmatory bias, which increases the importance given to information congruent with anxiety. The exposure–response prevention model is an important technique in the treatment of hypochondria. This model has been validated in patients presenting obsessive compulsive disorders. Patients are invited to confront ideas or thoughts that induce fear. This confrontation is repeated or prolonged in order to induce the extinction of anxiety. Another cognitive approach is the step-by-step cognitive “modelling”. During the first step the patient assesses his stress-inducing thoughts concerning his health, he also has to assess the frequency of inadequate medical treatments. During the next step, the therapist helps the patient correct automatic thoughts and false beliefs concerning his illness. The last step is a phase of consolidation. The therapist identifies factors triggering anxiety and excessive medical care. All these behavioural cognitive therapies can be performed in individual or in-group processes. Therapies proposed to patients presenting generalized anxiety disorders can be adapted to hypochondriacs. Lastly, hypochondria can be understood and treated as a form of addiction to medicine characterised by a craving for medical care, for biological exams and for different forms of medication. According to this conception, the treatment can be conducted as a form of detoxification: patients identify the frequency of their pathological behaviour and find strategies to reduce and/or control them. [Copyright &y& Elsevier]

Abstract: Without any proof, a governmental agency has decreed that Corticotulle® was not enough efficient to be reimbursed by National Health Security. Dealing with treatment of basal cell carcinoma, another governmental agency has published recommendations which even do not follow basic rules of logic. This paper points out that economical and political methods are not scientific or medical ones. [Copyright &y& Elsevier]

Abstract: The home healthcare of fragile or elderly people may be facilitated by IC technologies in order to monitor continuously the health level and to assist professionals, physicians and social workers. The assessment of the level of autonomy is one of the main indicators for adapting the level of care. The standardized tools (AGGIR or ADL) evaluate the capacities to perform autonomously the daily activities. These are user dependant. This paper presents scientific works on acquisition and interpretation of the signals derived from accelerometers in a Micro system, called “actimometer”. It can be embedded in the underwear to monitor continuously the level of activity, the capacities to displacements and transfers. The interpretation is so accurate to classify between different kinds of transfers in an ecological scenario. Results show that accelerometers data reproducibility depend on the two criteria: velocity and subject. In addition, a new method is able to differentiate BtS (Back-to-Sit) and StS (Sit-to-Stand) at the three velocities with a overall sensitivity and specificity equal to 95.32 and 96.10% respectively. Finally, the transition duration is determined for all trials. [Copyright &y& Elsevier]

Abstract: In opposition to a widespread belief in psychiatry, mental disorders per se, without alcohol or drug abuse, represent a risk for violence against others, including homicide, that is significantly higher than that of the general population. The present paper extensively reviews the scientific literature during the past 15 years and present their findings in a summary table. The contradictory results of the notorious McArthur study are also presented and critically discussed. Elevated risks of assaults are more closely associated with a subgroup of patients showing one or more of the following characteristics: a history of previous violence; non compliance with antipsychotic medication and follow-up; alcohol and/or illegal drug abuse; violent fantasies; acute psychotic symptoms; and cerebral damage. Although violence associated with mental disorders is significantly higher than that observed among the general population, the absolute number of assaults committed by patients is still low. Between 85 and 97% of violent offenders are not mentally ill. Certain aspects of the deinstitutionalization, such as lack of outpatient resources and a modification of the law reflecting more concerns for the rights of the patients might provoke health care interruptions. However, a clinical commitment relayed by legal interventions in case of danger generate significant reduction of the risks for violence. [Copyright &y& Elsevier]

Abstract: Adjuvant Radiotherapy has been shown to significantly reduce locoregional recurrence but this advantage is associated with increased cardiovascular and pulmonary morbidities. All uncertainties inherent to conformal radiation therapy must be identified in order to increase the precision of treatment; misestimation of these uncertainties increases the potential risk of geometrical misses with, as a consequence, underdosage of the tumor and/or overdosage of healthy tissues. Geometric uncertainties due to respiratory movements or set-up errors are well known. Two strategies have been proposed to limit their effect: quantification of these uncertainties, which are then taken into account in the final calculation of safety margins and/or reduction of respiratory and set-up uncertainties by an efficient immobilization or gating systems. Measured on portal films with two tangential fields, CLD (central lung distance), defined as the distance between the deep field edge and the interior chest wall at the central axis, seems to be the best predictor of set-up uncertainties. Using CLD, estimated mean set-up errors from the literature are 3.8 and 3.2 mm for the systematic and random errors respectively. These depend partly on the type of immobilization device and could be reduced by the use of portal imaging systems. Furthermore, breast is mobile during respiration with motion amplitude as high as 0.8 to 10 mm in the anteroposterior direction. Respiratory gating techniques, currently on evaluation, have the potential to reduce effect of these movements. Each radiotherapy department should perform its own assessments and determine the geometric uncertainties with respect of the equipment used and its particular treatment practices. This paper is a review of the main geometric uncertainties in breast treatment, due to respiration and set-up, and solutions proposed to limit their impact. [Copyright &y& Elsevier]

Abstract: The lateral brachial flap is a fascio-cutaneus flap. This flap is secured. The functional and cosmetic sequelae are limited. The authors propose in this paper its utilisation as free flap in the reconstruction of facial defects. Thanks to its low morbidity, this free flap may be used in old patients. [Copyright &y& Elsevier]

Abstract: Diabetes is one of the most common chronic diseases in our society. While insulin treatment for diabetes type I could delay and reduce the incidence of diabetic complications, it is associated with an increased risk of severe hypoglycemia. To restore physiologic insulin metabolism, transplantation of insulin producing cells (Pancreatic Beta cells) represent the sole available therapy. It could be done either through pancreas or islet of Langerhans transplantation. In this paper, we review actual knowledge regarding these two types of transplantations. [Copyright &y& Elsevier]

Objective – We conducted a survey regarding the organization of medical rescue during major events (catastrophes with limited effects) occurring in urban areas (Paris and immediate suburbs). The goal of this work was to study the availability of on site medical help and the real needs.Study design – Retrospective survey.Methods – Thirty-eight major events were analysed between 1988 and 2000. The median number (25th–75th percentiles) of victims per event was 42 (21–68) (range 8 to 424).Results – The median percentage of true emergencies (TE) was 5% with regard to the total number of victims per event. Thirty minutes after the event, 92% of the sites had a number of physician-manned ambulances greater than the number of severe victims. The median time to first evacuation was 79 (62–102) min.Conclusion – Disasters with limited effect occurrence in Paris and its immediate suburbs are characterized by a small percentage of TE and by a constant oversupply of medical means onsite. These observations led us to propose a new organization of medical rescue during this type of catastrophe, abandoning the classical notion of forward medical command post (FMCP) for a collection point of medical services (CPMS) consisting all means of evacuation (physician-manned and other ambulances). Also, a new type of victim identification, based on hospital base-station medical direction is discussed in this paper. [Copyright &y& Elsevier]

This paper reports the patient care experience during the trajectory of the radiotherapy. Plights are multiple. Patients are confronted with a complex and unknown distressing space, an irrelevant information, a banalisation of side effects, an isolation with a frequent inadequate support of their family or the caregivers team, with the fear of a definitive abandonment at the end of the treatment without conforting follow-up. It is imperative to state a real policy in order to improve the patient support. Sensibilisation and training of the caregivers, in spite of a frequent overbooking technical work, is required in a pluridisciplinary approach to provide a relevant reception with the collaboration of psychologists, social workers and self care groups and associations. The personal implication of the physicians and technologists is also essential. The simple smile is the intangible proof of the reliable emotional support. [Copyright &y& Elsevier]

Objective: The starting point of the French conference of consensus concerning arousal after coma was to answer the following question: “How can we define the ways of going from coma to arousal and their clinical levels?”Materials and method: A team of readers have picked up in the literature one hundred and fifty papers, out of which fifty six have been analysed.Results: From this analysis, three points emerged: The concepts of coma and arousal; The conditions of evolution from coma to arousal; Various groups of patients depending on their expressing arousal. One could not find any consensual model concerning the different ways of going from coma to arousal. The variability of the technics and the changing validity of all scores did not allow the conditions of arousal to reach a satisfactory level of proof. The Glasgow Coma Scale (GCS) is the recognised standard for severe wakefulness’ impairment, but it is not sensitive enough while patients’ arousing. The Glasgow Outcome Scale (GOS) takes into account the patients’ situations far later and does not include situations such as Minimally Conscious States (MCS). That’s why we face multiple scores, either ordinal, or categorial, all tending to evaluate the slow levels of arousal.Conclusion: Clinical findings concerning arousal are to be completed by non-clinical data. This would be greatly helpful to define appropriate management concerning individualized groups of patients. At this stage, another challenge for clinicians is to make the difference between emerging wakefulness and growing conscious activity. [Copyright &y& Elsevier]

The relationship between volume and surgical outcome seems logical, but needs to be demonstrated in the real world. A qualitative systematic review has been conducted to verify this hypothesis. Five systematic reviews and hundred original papers have been retreived and analysed. Most of the studies were retrospective and used administrative data instead of medical charts. Moreover few studies involved a good case mix adjustment when comparing surgical units or individual surgeons. These methodological flaws do not allow any evidence based conclusions. Even though a positive relationship is suggested for surgical units, the relationship between volume and outcome was however less obvious for an individual surgeon. There is some evidence that the relationship varied greatly according to the specialty or the procedure evaluated. A new approach based on predictive scores comparing expected versus observed outcomes is mandatory and seems to be the best way to assess objectively the relationship between surgical volume and outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Juvenile idiopathic arthritis (JIA) starts, by definition, before the age of 16 years, most cases occurring in early childhood. While for 50% of patients, especially those with the oligoarticular form, the disease declines during childhood, 30 to 40% of children with enter adulthood with their active disease. More frequent use of biologics will probably increase the rate of remission, however, the follow-up of children who became adults will be still necessary; transition to adult care happens during adolescence and is challenging for children, parents and caregivers. So, following what has been already done in other chronic diseases, transition clinics were set up in the United States and in Europe. This paper reviews publications on transition programs and clinics in JIA, underlines their limits and suggests some clues for improvement. [Copyright &y& Elsevier]

Summary: Extensive evidence related to thromboembolism risk and its prevention are available to guide health care providers. The 8th ACCP Evidence-Based Clinical Practice Guidelines were published in June 2008. The chapter on venous thromboembolism prophylaxis is the result of the collaboration of six senior authors with expertise in thrombosis, surgery, medicine, and critical appraisal. The methodology and the philosophy of these guidelines are explained in this paper and the major recommendations dealing with perioperative thromboprophylaxis are summarized. [Copyright &y& Elsevier]