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Dans le contexte actuel de la crise écologique et de la pandémie de Covid-19, alors qu’il est nécessaire de “repenser les rapports entre humains et non-humains”(Philippe Descola), cet article propose une relecture comparée de deux œuvres issues de la littérature de langue allemande, parues à douze ans d’intervalle, en pleine guerre froide, “Die Wand” (1963) de l’auteure autrichienne Marlen Haushofer, et “Minotaurus: Eine Ballade” (1985) de l’écrivain suisse Friedrich Dürrenmatt. Je m’intéresserai dans ces récits à ce qui fait et défait les collectifs, à ce que Marielle Macé a appelé la “grammaire des attachements”.Comment s’exprime par les mots, notamment les pronoms personnels, le travail qui consiste à se nouer les uns aux autres, et ces liens se nouent-ils de façon juste? Les deux ouvrages étudiés parviennent-ils à définir un “nous”, à faire émerger une communauté des organismes vivants, humains et non-humains? L’article s’interrogera sur l’apport de la littérature à la “composition d’un monde commun”(Bruno Latour), en se demandant si les scenarii proposés dans les deux œuvres rendent possible un “espoir actif”(Joanna Macy), et ce qu’ils nous apprennent sur l’histoire de l’idée de nature à l’heure des grands bouleversements écologiques., In the context of the current environmental crisis and Covid-19 pandemic, as it is becoming increasingly urgent to “rethink the relationships between human and non-human beings” (Philippe Descola), this paper offers a comparative reading of two works of German-language literature, both published, within a space of twelve years, during the Cold War: “Die Wand” (1963) by Austrian writer Marlen Haushofer and “Minotaurus: Eine Ballade” (1985) by Swiss writer Friedrich Dürrenmatt. In these two narratives, I will focus on the way communities are made and unmade, on what Marielle Macé has defined as “the grammar of attachments”. How do words, especially personal pronouns, convey the process by which beings connect one to the other, and are the connections made solid and harmonious ones? Do these two works manage to give rise to a community of living, human and non-human entities? This paper will examine the role of literature in building “a common world” (Bruno Latour), asking whether the scripts outlined in the two books can raise “active hope” (Joanna Macy) and what they teach us about the history of the concept of nature in a time of great environmental change., En el contexto actual de la crisis ecológica y de la pandemia de Covid-19, en un momento en el que es necesario "repensar la relación entre los humanos y los no humanos" (Philippe Descola), este artículo propone una relectura comparada de dos obras de la literatura en lengua alemana, publicadas con doce años de diferencia, en plena Guerra Fría, “El muro” (1963) de la autora austriaca Marlen Haushofer, y “Minotaure: Una balada” (1985) del escritor suizo Friedrich Dürrenmatt. En estas historias me interesaré por lo que hace y deshace los colectivos, por lo que Marielle Macé ha llamado la "gramática de los apegos". ¿Cómo se expresa con palabras el trabajo de vinculación con los demás, sobre todo con pronombres personales, y se vinculan de forma correcta? ¿Logran las dos obras estudiadas definir un "nosotros", poner de manifiesto una comunidad de organismos vivos, humanos y no humanos? El artículo examinará la contribución de la literatura a la "composición de un mundo común" (Bruno Latour), preguntándose si los escenarios propuestos en las dos obras hacen posible una "esperanza activa" (Joanna Macy), y lo que nos enseñan sobre la historia de la idea de naturaleza en una época de gran agitación ecológica.

Objective The objective of this paper is to provide an overview of the provision and organization of forensic mental health services around the world. In particular, we attempt to address the following question: What system-level characteristics are important to consider in relation to the organization and structure of forensic mental health services? Methods To do so, we synthesize publicly accessible information, identified through Academic Search Complete (EBSCO), ProQuest Central, Scopus, PsycInfo, Google Scholar and Google, to describe how forensic systems are organized throughout the world. We examine the fundamental principles in the organization of services and examine potential quality indicators. Results This review is a steppingstone for the identification of best practices. Based on these fundamental principles, an efficient forensic mental health system would include the following elements: providing a comprehensive and balanced continuum of services; integrating services within and between systems; matching services to individual need; adhering to human rights; responding to population diversity; and using the best available evidence to make system-wide improvements. Conclusion Though all of these system-level principles are important, we focus on how the first three (service continuum, system integration, and service matching) may be applied to the organization of forensic mental health services.

Objectives Exposure to repeated traumatic events during childhood and adolescence is associated with high prevalences of mental illness, addictions, physical health conditions, and psychosocial difficulties (Felitti et al., 2019). The most common consequence of exposure to trauma is violence towards self and others (Hughes et al., 2017). The very high prevalence of complex trauma among forensic mental health service users challenges these settings to modify their practices, training approaches, policies, and service delivery approaches. The objective of this article is to contribute to such a transformation of forensic mental health services by clarifying the impacts of complex trauma on the trajectories and experiences of forensic mental health services users, as well as practices responding to complex trauma. Methods We reviewed the published and grey literature on complex trauma among forensic mental health service users. After synthesizing the findings, they were contrasted with our experiences as clinicians and researchers in the field of forensic mental health care through the development of a case vignette. Results We first identify the role of complex trauma and victimization in the development and maintenance of violent behaviours. We describe the negative experiences of services and care settings reported by individuals with complex trauma in the absence of recognition and understanding of traumatic experiences and their impacts. We highlight the fundamental principles of trauma-informed care (trust and transparency; safety; peer support; collaboration and reciprocity; empowerment and choice; sensitivity to gender, cultural and historical differences), as well as the clinical and organizational approaches emerging from those principles. Next, we describe the approaches developed internationally to apply and implement trauma-informed care in forensic mental health setting, and the opportunities and challenges associated with their implementation in the Québec context. Conclusion To date, few studies have documented and evaluated the implementation of trauma-informed care in forensic mental health settings. The literature reviewed in this paper indicates that an in-depth understanding of complex trauma among forensic mental health service users should be at the core of contemporary forensic research, policies and practices.

The extension of biological inheritance beyond gene-centrism is at the center of many debates in evolutionary biology, but it has been relatively ignored in the field of biomedicine. The purpose of this prospective paper is to highlight the potential impact of a new vision of inheritance on medical theory, notably on the concept of hereditary disease. It is also to underline some related practical and social issues.L’hérédité étendue en biomédecine - Briser le silence.L’extension du concept d’hérédité au-delà du tout génétique a fait l’objet de nombreux débats en biologie de l’évolution, mais elle a été relativement ignorée dans le champ de la biomédecine. L’objectif de cet article prospectif est de souligner les conséquences potentielles d’une vision renouvelée de l’hérédité sur la théorie médicale, notamment sur le concept de maladie héréditaire, ainsi que de mettre en évidence certains enjeux pratiques et sociaux connexes.

Cerebellar ataxia can be caused by neoplasia, toxics (drugs, heavy metals, alcohol), infection, vascular lesions or auto-immune and paraneoplastic pathologies. Neuroimaging must be performed urgently in case of sudden onset and serologies as well as a lumbar puncture should be performed. Several case reports of ataxia associated with COVID-19 have been published, however the underlying pathogenic mechanisms remain unclear. This is a diagnosis of exclusion when other causes are ruled out and when the ataxia appears simultaneously to COVID-19 infection. We lack data on best management, but the prognosis appears mostly favorable with good functional recovery without any specific treatment. This paper describes the case of a patient who developed a cerebellar ataxia as the only neurological manifestation of a SARS-CoV-2 infection.Une ataxie cérébelleuse peut être causée par un processus (para)néoplasique, auto-imun, une exposition toxique, une infection ou une lésion vasculaire. Une imagerie doit être réalisée en urgence devant toute atteinte aiguë et le bilan devrait être complété par des sérologies larges et une ponction lombaire. Plusieurs cas d’ataxie liée au Covid-19 ont été décrits, dont le mécanisme étiopathogénique reste incomplètement élucidé, le diagnostic se faisant plutôt par exclusion lorsque les symptômes apparaissent de manière concomitante à l’infection. Des données manquent sur la prise en charge mais le pronostic semble favorable, avec une bonne récupération fonctionnelle. Cet article décrit le cas d’une patiente ayant présenté une ataxie cérébelleuse comme symptôme neurologique isolé contemporain d’une infection à SARS-CoV-2.

This paper reviews the literature to propose guidelines for managing patients with early-intermediate stage chronic lymphocytic leukemia (CLL). Clinical and biological parameters are sufficient to identify a cohort of patients with high-risk CLL at diagnosis who will have disease progression: anemia (Hb100 g/l) or thrombocytopenia (platelets100 G/l), bone marrow infiltration (30% lymphocytes), a rapid doubling time (less than 6 months) or lymphocytes above 300 g/L, splenomegaly and massive lymphadenopathy, systemic symptoms, uncontrolled autoimmune complications. Patients without those characteristics have low-risk CLL. In the absence of evidence of survival benefit in low-risk CLL, there is no indication for treatment and patients should be followed up by physical examination and complete blood count once or twice a year.

Multidisciplinary prehospital medicine is more than ever a challenging field of practice, with increasingly complex and polymorbid patients and numerous caregivers' participation. Throughout a clinical case, this paper offers a review of different tools currently in development (point of care ultrasonography, digital patient file) in order to improve solutions and outcomes for patients.Travailler en interdisciplinarité dans le préhospitalier n’a jamais été aussi important, face à des patients de plus en plus complexes et polymorbides, et dont la prise en charge dépend de nombreux acteurs du système de santé. Au travers d’une vignette clinique, cet article propose des pistes de développement d’outils (ultrason point of care, dossier électronique du patient) permettant une prise en charge ambulatoire interprofessionnelle plus efficiente.

Class II extraction approach by means of maxillary first premolars represents a common treatment strategy in order to reduce the overjet and create a stable Class I canine relationship and Class II molar relationship. The objective of this paper is to describe digital planning protocol and complete clinical phases of space closure in Class II malocclusion treatment in adult patient.The accuracy of movements and correction of dental parameters has improved exponentially in recent years, as a result of continuous research performed in aligner orthodontics. However, the most complex movement to realize with aligners is the apical movement, but the application of the G6 protocol for managing extractive cases allows to obtain the final parallelism of the roots with a control of the tipping managed on the digital plan as an overcorrection (overtipping) of the roots adjacent to the extraction site. Through the description of two cases, this article will present the application of the specific protocol for first premolars extraction in order to manage anchorage and closure of extraction spaces.All patients finished with proper OVJ and OVB with a Class II molar relationship and Class I canine relationship respecting face balance and smile arc.The Invisalign G6 protocol through the use of SmartStage™ technology combined with SmartForce™ features provides vertical control during anterior sector retraction and teeth body movement maintaining maximum posterior anchorage.Le traitement de la classe II par extraction des premières prémolaires maxillaires représente une stratégie de traitement répandue dont le but est de réduire le surplomb horizontal (overjet) et de créer une classe I canine stable avec une classe II molaire thérapeutique. L’objectif de cet article était de décrire le protocole digital et les différentes phases cliniques de fermeture des espaces dans les cas de malocclusion de classe II chez les patients adultes.La précision des mouvements et de la correction des paramètres dentaires s’est améliorée de façon exponentielle ces dernières années, grâce à la recherche continue effectuée dans le domaine de l’orthodontie par aligneurs. Cependant, le mouvement le plus complexe à réaliser avec les aligneurs est le déplacement apical, mais l’application du protocole G6 pour la gestion des cas d’extraction permet d’obtenir le parallélisme final des racines avec un contrôle du tipping géré sur le plan numérique comme une surcorrection (overtipping) des racines adjacentes au site d’extraction. À travers la description de deux cas, cet article présentera l’application du protocole spécifique pour la première extraction des prémolaires afin de gérer l’ancrage et la fermeture des espaces d’extraction.Tous les patients ont terminé avec un surplomb vertical et horizontal correct avec une relation molaire de classe II et une relation canine de classe I respectant l’équilibre du visage et l’arc du sourire.Le protocole Invisalign G6, grâce à l’utilisation de la technologie SmartStage™ combinée aux fonctionnalités SmartForce™, permet un contrôle vertical pendant la rétraction du secteur antérieur et le mouvement des dents, en maintenant un ancrage postérieur maximal.

Decision aids (DAs) help patients participate in healthcare decisions by improving knowledge and clarifying values and preferences, thus favoring a more active role in the decision process. DAs exist as a physical support (paper, DVD, audio) or computerized formats. They can be used independently by patients before and after consultations, or with a health professional during consultations. Unisanté has created a DA for use during consultations presenting available smoking cessation aids (www.howtoquit.ch). A local study showed that the DA is considered easy to use and useful by the doctors interviewed. The use of DAs in addictions to other substances, in conjunction with shared decision making, shows a favourable effect on the involvement of patients in their health and therapeutic adherence.Les outils d’aide à la décision (AD) soutiennent les patient-e-s dans leurs choix médicaux en majorant leurs connaissances et en clarifiant leurs valeurs et préférences, ce qui leur permet de s’impliquer dans le processus décisionnel. Les AD existent en tant que supports physiques (papier, DVD) ou informatiques. Ils peuvent être utilisés par les patient-e-s avant/après la consultation ou avec le-la professionnel-le de santé durant la consultation. Unisanté a créé un AD présentant les aides à l’arrêt du tabac durant la consultation. Une étude locale a montré que l’usage de celui-ci a été jugé simple et utile par les médecins. L’utilisation d’AD dans les addictions à d’autres substances, renforcée par des entretiens de décision partagée, montre un effet favorable sur l’implication des patient-e-s et sur l’adhésion thérapeutique.

Decision aids (DAs) help patients participate in healthcare decisions by improving knowledge and clarifying values and preferences, thus favoring a more active role in the decision process. DAs exist as a physical support (paper, DVD, audio) or computerized formats. They can be used independently by patients before and after consultations, or with a health professional during consultations. Unisanté has created a DA for use during consultations presenting available smoking cessation aids (www.howtoquit.ch). A local study showed that the DA is considered easy to use and useful by the doctors interviewed. The use of DAs in addictions to other substances, in conjunction with shared decision making, shows a favourable effect on the involvement of patients in their health and therapeutic adherence.

While governments have focused efforts on implementing health measures such as physical distancing and confinement to protect communities from the spread of COVID-19, some researchers focused on the significant impact of these measures on mental health and well-being. Persons with mental disorders who are both institutionalized and justice-involved in psychiatric and forensic hospitals find themselves more vulnerable to these measures and more limited in their movements and activities.The purpose of this paper is to examine the changes in practice in response to the pandemic and their potential impact on individuals in institutional settings.A rapid review including 69 publications identified nine major themes in the literature, which will serve as a framework to analyze the experience of one forensic psychiatry institution in Canada. These themes are: 1) population-specific vulnerability factors; 2) staff management and training; 3) early discharge, parole, and community integration; 4) management of contagion in closed spaces; 5) sanitary measures and personal protective equipment; 6) care and service continuity; 7) use of technology to maintain social ties and services; 8) legal mechanisms and individual rights; and 9) post-pandemic realities.Although this is the first pandemic of such international magnitude, experts point to an increase in epidemics over the past decade and continued growth in the coming decades. It is thus essential to learn from this health crisis in order to be prepared and minimize their potential impact on vulnerable populations in the future. The reflections presented here could be contrasted with the lived-experiences of people in institutions in order to nuance the data and propose new strategies.

In 2020, the COVID-19 health crisis affected all regions of the world, not sparing people already vulnerable to other viral epidemics such as HIV or HCV and/or those in precarious or socially marginalized situations. This is particularly the case for drug users or sex workers.Coalition PLUS, a network of associations fighting against HIV and viral hepatitis which defends and promotes the community-based approach, and its partners, have set up a multi-country community-based research project aimed at documenting the impact of the health crisis on the fight against HIV and viral hepatitis (key populations and community workers/activists), as well as the community responses put in place (EPIC survey).The objective of this paper is to reflect on the implementation of this community-based research study during the COVID-19 health crisis, and in particular the unforeseen difficulties to which the community-based research process had to confront and adapt. The goal is to draw lessons on what worked (and what did not work) in order to capitalize on community-based research practices during this pandemic and subsequently, facilitate the implementation of new research projects in similar contexts.

In France,#8220;the pill crisis#8221; has brought into question the centrality of oral contraception within the#8220;contraceptive standard#8221;, as well as the drawbacks associated with its use, and is more widely part of a dynamic of raising awareness about medical and gynecological violence, at work since the early 2010s.This paper intends to question the medical and gynecological violence faced by women seeking medical attention in order to access what is supposed to be a condition for their emancipation#160;: contraception.As part of a sociological research project on the prescriptions and uses of oral contraception, nearly seventy interviews were conducted with seventeen users of oral contraception and thirty-one health professionals authorized to prescribe contraception. Ninety-five medical and gynecological consultations were also observed, in both public and private medical facilities.The use of oral contraception requires regular medical consultation, increasingly exposing users to the risk of medical and gynecological violence, with lack of consent at its core. The case study of a gynecological consultation, as well as the analysis of interviews and observations, reveal various forms of medical violence, with a focus on the patients#8217; dependence on the medical profession.The interconnectedness of these different forms of medical and gynecological violence encourages us to consider them as part of a continuum of gender violence. An ethical caring stance makes it possible to guard against these situations.

People reporting electromagnetic hypersensitivity (EHS) attribute various functional disorders to their exposure to electromagnetic fields (EMF). To date, the results of provocation studies do not support the existence of a causal relationship between EMF and the reported symptoms. However, these studies suffer from various methodological limitations, including low statistical power due to an insufficient number of volunteers.The objective of this paper is to present the motivations of EHS people who participated in co-creation workshops towards the development of a provocation protocol that would overcome the limitations of existing studies and improve EHS knowledge.In a first phase, participants were invited to discuss the reasons for (not) participating in such a provocation study in order to understand barriers and challenges. Among the drivers, the improvement of the knowledge and the sensitization of the medical profession, as well as the official recognition of EHS and its implications are of great importance. The participants also stress the interest of getting to know themselves better and see the study as a step in the development of therapeutic tools. Among the barriers, people emphasize fears about the project independence and results neutrality, as well as methodological choices. Some also highlight the consequences of the test on their health (suffering) and social aspects.We identify precautions and recommendations for the implementation of a collaborative work with EHS people and in their perennial inclusion in an exposure study.

Despite an increasing number of therapeutic indications, there are no specific recommendations regarding the management of PARP inhibitors other than what is specified in the SmPC of each substance. A Delphi French consensus was conducted to establish practical guidelines to meet the needs identified by healthcare professionals and patients.Following the Delphi method, statements to optimize PARP inhibitor management were drafted by a multidisciplinary Steering Committee made up of 17 experts. These statements were submitted to the independent and anonymous vote of clinicians involved in treating patients on PARP inhibitors.This article presents 52 statements on the following topics: initiation and treatment; management of adverse events (hematological effects, gastrointestinal effects, renal effects, pulmonary effects, cutaneous effects, hypertension, insomnia, fatigue, dizziness); special populations and situations; communication with the patient; adherence. Forty-nine statements obtained voter consensus after 3 voting rounds. A hematologist and a nephrologist supplemented this task by drafting an expert opinion on the risk of occurrence of secondary leukemia and nephrological toxicity.This paper is the first Delphi consensus on the practical management of PARP inhibitors. The pragmatic recommendations resulting from this paper should make it possible to manage the side effects of PARP inhibitors better and thus prevent early treatment discontinuation and improve patient adherence by preserving quality of life.

The COVID-19 pandemic highlighted limitations in the current public health data infrastructure, and the need for a comprehensive, real-time, centralized, user-friendly data management system suitable for both disease surveillance and outbreak management. To address these issues, the Canadian Forces Health Services Group developed the webbased Canadian Armed Forces Surveillance and Outbreak Management System (CAF SOMS). This paper details the development of the CAF SOMS, provides formative evaluation results and includes a discussion of the lessons learned and intent to use the CAF SOMS in future to enhance the CAF's disease surveillance and outbreak management capability beyond COVID-19.La pandémie de COVID-19 a mis en évidence les limites de l’infrastructure actuelle de données sur la santé publique et le besoin d’un système de gestion des données en temps réel complet, centralisé et convivial qui convienne à la fois à la surveillance des maladies et à la gestion des éclosions. Pour remédier à la situation, le Groupe des Services de santé des Forces canadiennes a élaboré le Système de surveillance et de gestion des éclosions des Forces armées canadiennes (SSGE FAC) sur le Web. Cet article décrit en détail l’élaboration du SSGE FAC, fournit les résultats de l’évaluation formative du SSGE FAC et présente une analyse des constats dégagés et des perspectives d’utilisation du SSGE FAC pour améliorer la capacité de surveillance des maladies et de gestion des éclosions des FAC après la pandémie de COVID-19.The Canadian Armed Forces Surveillance and Outbreak Management System (CAF SOMS) was developed to address gaps in information management identified during the COVID-19 pandemic. Integrating a formative evaluation in the phased development and implementation helped to address issues with the system prior to its national roll-out. Lessons learned from its development, implementation and evaluation can inform further refinement and future applications of the CAF SOMS, and potentially of other public health information systems. Increased uptake of the system, integration with electronic records and alignment with the pan-Canadian Health Data Strategy may enhance responses to disease threats and improve CAF health outcomes.Le Système de surveillance et de gestion des éclosions des Forces armées canadiennes (SSGE FAC) a été élaboré pour combler les lacunes en matière de gestion de l’information relevées pendant la pandémie de COVID-19. L’intégration d’une évaluation formative dans le processus d’élaboration et de mise en oeuvre par étapes a aidé à régler les problèmes liés au système avant son déploiement à l’échelle nationale. Les constats dégagés lors de l’élaboration, de la mise en oeuvre et de l’évaluation du système vont pouvoir contribuer à l’amélioration et aux applications futures du SSGE FAC et peut-être même d’autres systèmes d’information en santé publique. L’utilisation accrue du système, son intégration aux dossiers médicaux électroniques et son harmonisation avec la Stratégie pancanadienne de données sur la santé contribuerait vraisemblablement à lutter contre les menaces liées aux maladies et améliorer les résultats en matière de santé des FAC.

The Canadian Armed Forces (CAF) deployed 2595 regular and reserve force personnel on Operation (Op) LASER, the CAF's mission to provide support to civilian staff at longterm care facilities in Ontario and in the Centres d'hébergement de soins de longue durée in Quebec. An online longitudinal survey and in-depth virtual discussions were conducted by a multidisciplinary team of researchers with complementary expertise. This paper highlights the challenges encountered in conducting this research and their impact on the design and implementation of the study, and provides lessons learned that may be useful to researchers responding to similar public health crises in the future.Les Forces armées canadiennes (FAC) ont déployé 2 595 membres de la Force régulière et de la Force de réserve dans le cadre de l’Opération LASER (Op LASER), la mission des FAC destinée à soutenir le personnel civil des établissements de soins de longue durée en Ontario et des centres d’hébergement et de soins de longue durée au Québec. Les membres d’une équipe multidisciplinaire de chercheurs possédant une expertise complémentaire ont dirigé une enquête longitudinale en ligne et des discussions virtuelles approfondies. Cet article met en lumière les défis que les chercheurs ont dû relever dans le cadre de l’étude et l’incidence de ces obstacles sur la conception et la mise en oeuvre de celle-ci. Il présente également les constats qui en ont été dégagés et qui sont susceptibles d’être utiles aux chercheurs qui auront à intervenir au cours d’autres crises de santé publique similaires.There are a number of challenges involved in conducting longitudinal research in an applied military setting during a global public health crisis such as the COVID-19 pandemic. These challenges include but are not limited to a sudden transition to a distributed remote work environment, tight timelines, the need to obtain approvals from different agencies and departments, having to prioritize multiple study objectives, and survey fatigue. To overcome these challenges in future public health crises, it is important to (1) develop and maintain collaborative networks across government, academia and industry; (2) develop a standard set of pre-deployment demographic and health indicators to establish a baseline; and (3) use mixed methods approaches for a richer understanding of mental health trajectories following stressful events.La réalisation d’une enquête longitudinale dans un contexte militaire concret pendant une crise mondiale de santé publique, comme la pandémie de COVID-19, vient avec son lot de défis. Parmi ces défis, on peut relever une transition subite vers un environnement de travail à distance, des délais serrés, la nécessité d’obtenir des approbations de différents organismes et ministères, la nécessité de prioriser plusieurs objectifs d’étude et la lassitude à l’égard des enquêtes. Pour relever ces défis au cours des futures crises de santé publique, il sera essentiel : 1) de créer et d’entretenir des réseaux de collaboration qui relieront le gouvernement, le milieu universitaire et les divers secteurs d’activité, 2) de créer un ensemble normalisé d’indicateurs démographiques et sanitaires avant le déploiement, en vue de l’obtention de données de référence et 3) de recourir à des méthodes mixtes pour mieux comprendre les trajectoires en matière de santé mentale à la suite d’événements stressants.

Pediatric cancers are rare, representing almost 2,500 new cases each year in France meaning 1% of all cancers. Since 2012, a twice-monthly national web-based conference was held in France. Any patient with a pediatric type cancer requiring radiotherapy can be discussed. It aims at answering the physician with specific radiation therapy questions on rare and complex indications, at promoting the use of referential and the inclusion into clinical protocols.From 2012 to 2018, 1,078 cases were discussed for 940 patients in 142 meetings. Mean age was 10 years old (4 months to 45 years). The mean number of attendants was 6 (2 to 32). We review in this paper the main clinical features discussed in the web-conference and the decision of the web-conference. In 85% cases, the first treatment proposed was mostly accepted, but in 15%, other proposals were done (modifications of target volumes, doses or indications).Between 2012 and 2018, more than 1,000 pediatric irradiation cases were discussed in our web-based conference leading to 15% of change in radiation protocol. The rarity and the complexity of these situations need those meetings. They provide a place to improve the global knowledge and the quality of the treatments provided.

In order to promote biomedical research, the French ministry of Solidarity and Health has developed a software that is used to rate medical doctors according to their scientific production: the SIGAPS points (System of Interrogation, Management and Analysis of Scientific Publications). These points (1-32 points) are attributed after the publication of a scientific paper according to the quality of the journal (based on the impact factor) and the doctor's rank among the authors. These points are then transformed into a sum of money received by the health facility (1 point = approximately 648 euros), 4 years in a row. Does this "fee-for-service" encourage doctors to publish quickly at any price, regardless of the quality of their research?Qui veut gagner des points SIGAPS ?Afin de promouvoir la recherche en santé, le ministère des Solidarités et de la Santé a fait appel à un logiciel permettant de noter les médecins en fonction en leur production scientifique : les points SIGAPS (Système d’interrogation, de gestion et d’analyse des publications scientifiques). Ces points (entre 1 et 32 points) sont attribués aux auteurs de publications après la parution de leur article, selon la qualité de la revue dans laquelle ils publient (fondée sur son facteur d’impact) et selon leur rang dans la liste des auteurs. Ces points seront ensuite transformés en une somme d’argent qui sera perçue pendant 4 ans par l’établissement de santé auquel ils sont rattachés (1 point correspondant à 648 euros environ). Mais cette « rémunération à l’acte de recherche » ne pousse-t-elle pas les médecins à publier plus rapidement et surtout à tout prix, quelle que soit la qualité de leur recherche ?

The surgical notebooks (1945-1959) of General Gustave Ginestet are the last direct testimony of the quintessential period in which autoplastic techniques were used, before their twilight, favored by the advent of axial pedicle flaps, musculocutaneous flaps and later free flaps. They summarize all the refinements of the experience accumulated at the National Center for Reconstructive Surgery (Centre Médico-Chirurgical Foch-Suresnes). They appear to be more informative than the various books of the time, which were intended for an experienced public or for those benefiting from a companionship, thus eluding a certain number of precautionary advice, which are undoubtedly tacit but essential to obtain a successful operation in the hypothesis of their current use. This paper aims to establish the principles of historical surgical techniques and to integrate them into the management of patients in therapeutic impasse. One hundred and seven clinical situations requiring tissue displacement were analyzed by reconstructed region and by type of flap used. This technical view of the past, as close as possible to the daily practice of a famous reconstructive surgery center, does not offer absolute methodological or technical precepts. From the surgical notebooks studied, the only thing that emerges is a rigorous approach that allows us to contain a permanent doubt and an experimental process. This notion of constant evolution of the autoplastic practice, guided by its errors, intuitions and beliefs, highlights the importance of a surgical culture, which, with a humanistic approach, must be nourished by the paths of the past.

In our society, the number of gender affirming surgeries is increasing. Mastectomy is usually the initial surgical procedure performed for the treatment of gender dysphoria in transgender men. It has been shown to improve quality of life and to promote assimilation into the new genre. Creating an aesthetic male chest requires adjustment of the breast tissue volume, proper placement of nipple areola complex, and removal of the inframammary fold. Although many papers have been published on this topic, there is still no consensus as to which surgical technique should be preferred. This article deals with the procedures performed in our plastic surgery department at CHU in Liège and reviews the literature relating to the various surgical techniques, postoperative complications as well as patient satisfaction.Dans notre société, le nombre de chirurgies d’affirmation de genre est en augmentation. La mastectomie est généralement la procédure chirurgicale initiale réalisée dans le traitement de la dysphorie de genre chez l’homme transgenre. Il a été démontré qu’elle améliore la qualité de vie et favorise l’assimilation au nouveau genre. La création d’une poitrine masculine esthétique nécessite un ajustement du volume du tissu mammaire, un placement approprié de la plaque aréolo-mamelonnaire et la suppression du pli infra-mammaire. Bien que de nombreux articles aient été publiés sur le sujet, il n’y a pas encore de réel consensus quant à la technique chirurgicale à privilégier. Cet article fait le bilan des interventions réalisées au sein du Service de Chirurgie plastique au CHU de Liège et revoit la littérature relative aux différentes techniques chirurgicales utilisées, aux complications postopératoires ainsi qu’à la satisfaction des patients.

Significant advances have been made in 2021 in the areas of interventional cardiology, heart failure, cardiac imaging, electrophysiology and congenital heart disease. In addition to improving the screening, diagnosis and management of many heart diseases, these advances will change our daily practice. Moreover, the European Society of Cardiology has updated its guidelines on heart failure, valve disease, cardiac pacing and cardiovascular disease prevention. As in previous years, members of the Cardiology division of Lausanne University Hospital (CHUV) came together to select and present to you the papers that they considered to be the most important of the past year.

Significant advances have been made in 2021 in the areas of interventional cardiology, heart failure, cardiac imaging, electrophysiology and congenital heart disease. In addition to improving the screening, diagnosis and management of many heart diseases, these advances will change our daily practice. Moreover, the European Society of Cardiology has updated its guidelines on heart failure, valve disease, cardiac pacing and cardiovascular disease prevention. As in previous years, members of the Cardiology division of Lausanne University Hospital (CHUV) came together to select and present to you the papers that they considered to be the most important of the past year.De nombreux progrès ont été réalisés en 2021 dans les domaines de la cardiologie interventionnelle, de l’insuffisance cardiaque, de l’imagerie cardiaque, de l’électrophysiologie et des cardiopathies congénitales. En plus d’améliorer le dépistage, le diagnostic et la prise en charge de nombreuses cardiopathies, ces avancées vont faire évoluer notre pratique quotidienne. Par ailleurs, la Société européenne de cardiologie a mis à jour ses recommandations portant sur l’insuffisance cardiaque, les valvulopathies, la stimulation cardiaque et la prévention des maladies cardiovasculaires. Comme les années précédentes, les membres du Service de cardiologie du CHUV se sont réunis pour sélectionner et vous présenter les travaux qui leur ont semblé être les plus importants de l’année écoulée.

Ankle sprains are frequently encountered. They result most of the time in lesions of the lateral ligament complex. Nevertheless, in the context of an ankle sprains, more severe injuries including fracture of the lateral process of the talus, fracture of the base of the 5th metatarsal, tear of the medial ligament complex, lesion of the syndesmosis, sprain of the Chopart joint, and peroneal tendons luxation are potentially overlooked and, if treated inadequately, may be associated with poor functional outcome. The goal of the present paper is to make the emergency practitioner aware of these potential lesions, and to help him making the correct diagnosis in order to initiate the adequate treatment.

Ankle sprains are frequently encountered. They result most of the time in lesions of the lateral ligament complex. Nevertheless, in the context of an ankle sprains, more severe injuries including fracture of the lateral process of the talus, fracture of the base of the 5th metatarsal, tear of the medial ligament complex, lesion of the syndesmosis, sprain of the Chopart joint, and peroneal tendons luxation are potentially overlooked and, if treated inadequately, may be associated with poor functional outcome. The goal of the present paper is to make the emergency practitioner aware of these potential lesions, and to help him making the correct diagnosis in order to initiate the adequate treatment.Les entorses de cheville sont un motif de consultation très fréquent. Dans la plupart des cas, elles se limitent à des lésions de l’appareil ligamentaire externe. Toutefois, elles peuvent masquer des lésions plus graves incluant les fractures du processus latéral du talus, de la base du 5

Early discussion on palliative care with patients with advanced, progressive or terminal disease is difficult regardless patient's life expectancy. In Belgium, a Royal Decree sets the criteria to identify patients with palliative needs. For that purpose, the Palliative Care Indicators Tool (PICT) is proposed. This 3-step identification tool designed for physicians begins with the so-called surprise question, «Would you be surprised if your patient died in the next 6 to 12 months?». The second and third steps examine the fragility and incurability criteria, respectively. The surprise question intends to encourage the clinician to trust his/her intuition and to promote a reflection on patient's needs. The PICT facilitates communication between caregivers. Also, it makes possible early thinking about advanced care planning. Hence, it allows patients to receive palliative care in due time. In this paper, after reviewing the background of the surprise question, we shall examine the benefits and limitations of the surprise question.Parler de soins palliatifs précocement chez les patients lorsqu’ils se trouvent à un stade avancé ou terminal d’une maladie grave, évolutive, mettant en péril le pronostic vital, quelle que soit son espérance de vie, reste difficile. La loi belge s’est dotée en octobre 2018 d’un arrêté royal proposant le PICT (Palliative Care Indicators Tool). Cette échelle d’identification, conçue en 3 étapes, débute par la question surprise : «Seriez-vous surpris si votre patient venait à décéder dans les 6 à 12 prochains mois??». La deuxième étape et la troisième étape déterminent respectivement les critères de fragilité et d’incurabilité. La question surprise encourage le clinicien à faire confiance à son intuition et valorise une réflexion centrée sur les besoins du patient. L’utilisation de l’outil PICT peut faciliter la communication entre soignants, permettre d’aborder plus tôt la réflexion autour de la planification anticipée des soins et offrira ainsi aux patients des soins palliatifs en temps opportun. Cet article présente l’historique de la question surprise ainsi que ses avantages et ses limites.

Abdominal aortic aneurysm (AAA) represents an important public health problem. The early detection and treatment as well as follow-up of an AAA are important to reduce the high mortality rate associated with its rupture. Despite the decline of the prevalence of AAA in the last decades, the latest international recommendations have reaffirmed that screening in men remains cost-effective. In contrast, the data and recommendations for women are unclear. The best method for AAA screening is abdominal ultrasound. The aim of this paper is to present an up-to-date review of the indications for AAA screening based on the latest recommendations.L’anévrisme de l’aorte abdominale (AAA) reste toujours un problème de santé publique malgré les progrès technologiques réalisés dans sa prise en charge. Le diagnostic précoce et le traitement ainsi que le suivi d’un AAA sont importants pour prévenir le taux de mortalité très élevé associé à sa rupture. Bien que la prévalence de l’AAA ait diminué ces dernières décennies, les dernières recommandations internationales ont réaffirmé qu’un dépistage chez les hommes reste rentable. En revanche, les données et les recommandations concernant la femme ne sont pas claires. L’examen de choix pour le dépistage des AAA est l’échographie abdominale. Cet article vise à mettre à jour les indications de dépistage de l’AAA en fonction des dernières recommandations.

Denial of pregnancy is a public health problem due to maternal, fetal, and neonatal morbidity, affecting both physical and mental health. It generally involves an absence of the physical signals associated with pregnancy such as abdominal swelling, amenorrhea, weight gain, or even perception of fetal movements. Despite the potential consequences for mother and child, there is still little data on its clinical features and the neurocognitive mechanisms involved. In this paper, we provide an update on the clinical, socio-demographic, and psychopathological characteristics of pregnancy denial based on contemporary scientific literature. We first define denial of pregnancy by referring to the history of the concept, previous definitions, and nosographic classifications. We then detail the clinic of denial by distinguishing the physical and psychological symptoms of this disorder, then the socio-demographic, gynecological, and psychiatric characteristics. We describe the consequences of denial on the mother, infant, and the dyad, referring to situations of cryptic neonaticide. Finally, we show the importance of perinatal neuroscience research on maternal interoception to understand the mechanisms involved in denial of pregnancy, and improve their medical management in clinical practice.

This paper deals with the place in 2021 of artificial intelligence for screening of breast cancer in France et discusses of the different types of use and their performance in the literature (Standalone, Augmented radiologist, triage). Moreover, this paper will give an overview of the potential applications of AI in the future (Personalized screening, prediction of interval cancers).

This paper summarizes the main knowledge on mRNA vaccines in September 2021. The only contraindication for a 1st dose of vaccine is an allergy to one of the components of the vaccine, but a specialized consultation is possible for an eventual split vaccination under medical supervision. Serious side effects are rare and consist mainly of myocarditis, shingles and appendicitis, but the risk/benefit ratio is always favorable for vaccination. Efficacy against severe COVID-19 is90 % after 6 months, and this against all variants. It is recommended to vaccinate pregnant women. A 3rd dose is not recommended at this time, except for immunosuppressed individuals without detectable antibodies after 2 doses. Vaccine mixing is possible, including with a viral vector vaccine.Cet article résume les connaissances principales sur les vaccins à ARN messager en septembre 2021. La seule contre-indication pour une 1

This paper summarizes the main knowledge on mRNA vaccines in September 2021. The only contraindication for a 1st dose of vaccine is an allergy to one of the components of the vaccine, but a specialized consultation is possible for an eventual split vaccination under medical supervision. Serious side effects are rare and consist mainly of myocarditis, shingles and appendicitis, but the risk/benefit ratio is always favorable for vaccination. Efficacy against severe COVID-19 is > 90 % after 6 months, and this against all variants. It is recommended to vaccinate pregnant women. A 3rd dose is not recommended at this time, except for immunosuppressed individuals without detectable antibodies after 2 doses. Vaccine mixing is possible, including with a viral vector vaccine.

In recent years, research in artificial intelligence (AI) has experienced an unprecedented surge in the field of ophthalmology, in particular glaucoma. The diagnosis and follow-up of glaucoma is complex and relies on a body of clinical evidence and ancillary tests. This large amount of information from structural and functional testing of the optic nerve and macula makes glaucoma a particularly appropriate field for the application of AI. In this paper, we will review work using AI in the field of glaucoma, whether for screening, diagnosis or detection of progression. Many AI strategies have shown promising results for glaucoma detection using fundus photography, optical coherence tomography, or automated perimetry. The combination of these imaging modalities increases the performance of AI algorithms, with results comparable to those of humans. We will discuss potential applications as well as obstacles and limitations to the deployment and validation of such models. While there is no doubt that AI has the potential to revolutionize glaucoma management and screening, research in the coming years will need to address unavoidable questions regarding the clinical significance of such results and the explicability of the predictions.

Perinatal beliefs contribute to the experience of pregnancy and the process of parenthood. Many of these perinatal beliefs have been perpetuated and evolved over time and throughout the world, exerting their influence on the behavior of pregnant women in interaction with medical recommendations. These beliefs generally offer explanations for gravidic and puerperal phenomena, helping to reduce the uncertainty of parents faced with the biological, psychological and social transitions of pregnancy. But certain beliefs can also be harmful, and alter the maternal experience of pregnancy and postpartum. In this paper, we provide an overview of the beliefs associated with the perinatal period. We successively detail the beliefs concerning fertility, pregnancy, childbirth, and postpartum, specifying the cultural beliefs from other cultures interacting with medical recommendations. Finally, we propose a neurocognitive model of perinatal beliefs generation, and we show the need to know these beliefs to improve care in midwifery, obstetrics, and fetal medicine.

This systematic review aims to compare conventional corticotomy with minimally-invasive protocols (MIP). Electronic database, in MEDLINE and CENTRAL, and hand search were performed. Randomized controlled trials (RCTs) and randomized split-mouth designed studies (RSMSs) were selected for inclusion, reporting either the use of a corticotomy procedure or a MIP. The main outcomes were the rate/velocity of tooth movement, type of tooth movement observed, loss of anchorage, periodontal indexes, inflammatory mediators, root resorption, patient's pain experience, impact on the quality of life, and satisfaction. Twenty-two papers were included for the qualitative synthesis, from which ten RCTs and twelve RSMSs. Eighteen of them compared a conventional orthodontic treatment without and with a surgical adjunctive procedure, two with conventional corticotomy and sixteen with a MIP (piezocision, micro-osteoperforations (MOPs) or interseptal bone reduction). Four trials compared a surgical procedure to another one. Corticotomy, piezocision and MOPs are likely to accelerate tooth movement, in decreasing order. Pain is reported to be higher in experimental groups only on the first day after surgery. Patient satisfaction is high after surgical procedures. Loss of anchorage, periodontal indexes, or root resorption occurrence show no differences between groups. Corticotomy stands as the gold-standard procedure for surgically-assisted orthodontics, but piezocision appears as a good compromise solution as well as MOPs, in a lesser extent. MIP are known to accelerate tooth movement only during the first three months.

The implantation of health structures in Côte d'Ivoire to improve geographical accessibility to care remains unequal between rural and urban areas. The medical student has to decide on his or her career choice in this context, while also taking into account personal preferences. The aim of our study was to evaluate the factors influencing the speciality choice of medical students at the faculty of medicine of Félix Houphouët-Boigny University in Abidjan.Medical students enrolled in the 6th year completed an anonymous self-administered questionnaire. The questionnaire was in paper format and was divided into three parts: socio-demographic criteria; speciality choice; and factors influencing career choice. Students were asked to rate the extent to which they perceived each of the 24 items as influencing their career choice using a Likert scale ranging from 1 (no influence) to 5 (strong influence). The factors were compared according to the speciality choice (medical or surgical).The 3 most chosen specialties were: cardiology (17.9%), gynaecology-obstetrics (15.7%) and paediatrics (9.6%). The desire to take the internship competition was more frequent among students who chose a surgical speciality (p = 0.02). The choice of a medical speciality was more influenced by the willingness to work part-time (p = 0.04). Students who choose a medical speciality were more guided by social commitment than those who chose a surgical speciality (p = 0.04). In contrast, the latter were more influenced by prestige among colleagues (p = 0.04) and immediate postoperative outcomes (p = 0.01).The efficient equipment of health structures could contribute to the development of other less chosen specialities by making them more attractive. A reorganisation of the system with the deployment of teachers in regional hospitals with a minimum of equipment is indispensable in order to allow a "decentralization" of the specialization curriculum, especially for the surgical specialties.As for the aspiration to part-time work, it can be explained by the need to reconcile family and professional life, but also by a sometimes unspoken project to develop a lucrative extra-medical activity in order to make up insufficient wages.

A survey on smoking prevalence was conducted among staff at the Georges Pompidou and Corentin Celton hospitals in the framework of the "smoke-free hospital" project. It aimed to determine the smoking status of different categories of personnel, their desire to be helped to quit and, as regards healthcare staff, whether or not they were encouraging patients who smoked to try to quit.From February to May 2021, an anonymous survey was distributed, first on paper in the occupational health unit, and then online in all wards.All in all, 775 people, three quarters of whom were women, participated in the survey (15% of the workforce). Among the respondents, 27% said they smoked: 29.6% of the men and 26.1% of the women. Unsurprisingly, the age group with the highest prevalence was 18-24years. High prevalence was likewise found among technical and administrative staff. More than half of the smokers, who consumed an average of 8 cigarettes a day, were interested in receiving smoking cessation support. As regards smoking cessation support for patients, 49% of medical and nursing staff (70% of the doctors) frequently or systematically advised them to quit.Our results illustrate a need to reach high-prevalence categories of smokers in a hospital setting, the objective being to help them to consider quitting, and also a need to train health professionals in smoking cessation counseling.

Along other breakthroughs in computer sciences, such as artificial intelligence, virtual characters (i.e. digitally represented characters featuring a human appearance or not) are foreseen as potential providers of mental healthcare services. However, their current use in clinical practice is marginal and limited to an assistive role to help clinicians in their practices. Safety and efficiency concerns, as well as a general lack of knowledge and experience, may explain this discrepancy between the expected (sometimes futuristic) and current use of virtual characters. An overview of recent evidence would help pinpoint the main concerns and challenges pertaining to their use in mental healthcare. Objective This paper aims to inform relevant actors, including clinicians, on the potential of virtual characters in mental healthcare practices and to raise awareness on societal challenges regarding their use. Method A narrative literature review was conducted to summarize basic and clinical research findings, and to outline an in-depth discussion on various societal caveats related to the inclusion of virtual characters. Results Basic studies highlight several characteristics of the virtual characters that seem to influence patient-clinician interactions. These characteristics can be classified into two categories: perceptual (e.g. realism) and social features (i.e. attribution of social categories such as gender). To this day, many interventions and/or assessments using virtual characters have shown various levels of efficiency in mental health, and certain elements of a therapeutic relationship (e.g. alliance and empathy) may even be triggered during an interaction with a virtual character. To develop and increase the use of virtual characters, numerous socioeconomic and ethical issues must be examined. Although the accessibility and the availability of virtual characters are an undeniable advantage for their use in mental healthcare, some inequities about their application remain. In addition, the accumulation of biometric data (e.g. heart rate) could provide valuable information to clinicians and could help develop autonomous virtual characters, which raises concerns over issues of security and privacy. This paper proposes some recommendations to avoid such undesirable outcomes. Conclusion Due to their promising features, the inclusion of virtual characters will no doubt be increasingly prevalent in mental healthcare services. All involved actors should thus be informed about specific challenges raised by such breakthroughs. They should also actively participate in discussions regarding the development of virtual characters in order to adopt unified recommendations for their safe and ethical use in mental healthcare.

Objective To propose some key steps to facilitate the process of creating mental health smartphone applications (apps). Methods Brief presentation of the potential interest of apps and proposition of key steps for the creation of apps. The paper is based on a narrative review, a testimonial experience and some expert works. Results Apps have ubiquitous features that are particularly appealing for the mental health field. Potentially connected to multiple technologies, mobile and available at all times, they allow great design flexibility. In order to increase the chances of effectiveness and good dissemination of a given app, 9 principles could usefully guide the design of apps, in particular a good integration of end users around well-defined target objectives during the entire process of creating such tools. Conclusion The proposed key steps could facilitate the process of creating mental health apps.

Recent shark attacks in New Caledonia have prompted local authorities to elaborate a risk-management plan. The objective of the present paper is to produce detailed data on shark attacks that occurred in New Caledonian waters for the last few decades, as well as on the injuries of the victims, in order to inform rescue and medical services as well as authorities in charge of educating the public and providing security.Incidents involving sharks and humans in New Caledonia for the last six decades were included into a database. Sharks were tentatively identified to species according to the shape, size and other external characteristics of injuries to the victims, together with witness accounts. The severity of shark bites was evaluated against the scale proposed by A.K. Lentz and co-authors (Am Surg. 2010;76:101-6).Sixty-seven shark-attack cases were recorded in New Caledonia from 1958 to 2020, of which 13 were lethal. The majority of the attacks concerned spearfishers and freedivers collecting invertebrates (58.5% of total). In the last decades, shark attacks may have increased towards bathers, swimmers and snorkelers (18.5%), and people taking part in water sports including surf, kitesurf, windsurf and SUP foil (14%). One scuba diver was also attacked (1.5%). Twenty attacks including 8 lethal ones were ascribed to the tiger sharkFeeding incentive appeared to be a frequent factor triggering attacks. The education of the public should be promoted as a preventive measure aiming to reduce the risk of such accidents.

Since the early 1970s, the concept of quality of life has been the subject of increasing interest in the medical field, although no scientific consensus has emerged on how to define and measure it. The aim of this narrative review of the literature is to decrypt the notion of quality of life in the medical field, in order to enable clinicians-researchers and clinicians who use quality of life measurement instruments in clinical practice to form an informed and nuanced opinion on the issue. To do so, the paper is divided into three parts. Firstly, a brief overview of the origin of the concept in the medical field is given by exposing the main factors explaining its emergence and its rise in importance. Next, the plurality of definitions of quality of life and its derivatives (e.g. health-related quality of life), as well as its measurement instruments in the medical field, are explored. Finally, some benchmarks for the use of health-related quality of life instruments in clinical practice are presented.Depuis le début des années 70, la notion de qualité de vie fait l’objet d’un intérêt croissant dans le champ médical, sans pour autant que n’émerge un consensus scientifique sur une manière de la définir et de la mesurer. L’objectif de cette revue narrative de la littérature consiste à décrypter la notion de qualité de vie dans le champ médical afin de permettre aux cliniciens-chercheurs et aux cliniciens, qui utilisent des instruments de mesure de la qualité de vie en pratique clinique, de se forger un avis éclairé et nuancé sur la question. Pour ce faire, le papier se décline en trois parties. Tout d’abord, il fait état d’un bref aperçu de l’origine de la notion dans le champ médical en exposant, notamment, les principaux facteurs expliquant son émergence et son importance grandissante. Ensuite, il explore la pluralité de définitions de la qualité de vie et de ses dérivés (e.g. qualité de vie liée à la santé), ainsi que ses instruments de mesure dans le champ médical. Enfin, il présente quelques repères pour l’utilisation d’instruments de mesure de la qualité de vie liée à la santé en pratique clinique.

The availability for research of biobanked human biological materials and their derived data is submitted to several legal regulations, including informed consent. Empirical research about the understanding of the information disclosed is limited. The purpose of this paper is to analyze the appropriation of the oral and written information provided when the Informed Consent is collected for participation in tumor collection. Two materials have been collected: the description of the context of consent collecting based on interviews with different actors of one of the hospital sites concerned by the biobank and the analysis of consent forms by a group of individuals in poverty situations, using focus-group method. The description of the context shows the emotional situation related to the announcement of cancer and therefore difficulties understanding complex information in that very moment. They also pointed out the question of the patient's autonomy to give consent in the context of doctor-patient relationships in cancerology. The group insisted on the difficulty to understand the information disclosed, because of numerous and complex words and acronyms. On another hand, essential information isn't provided about risks and data sharing. Consulting a group of people in poverty situation is an issue of social justice: if patients with a low level of health literacy are able to take ownership of those questions, all the patients would be able to do it.

Context : The current COVID-19 context has placed nurses at the heart of the pandemic, due to the critical role they play within the population. However, media and professional discourses are influencing the identity and clinical practice of nurses.Objective : Review the literature on the construction of the popular identity of nurses and their roles during the COVID-19 pandemic.Method : Several data sources were consulted : Eureka, Google News, Education Resources Information Center (ERIC), Sociological Abstracts, Cumulative Index to Nursing Information and Allied Health Literature (CINAHL), MEDLINE, and Social Sciences Abstracts. Manual searches of government and professional sites were also conducted.Results : Of a total of 281 papers indexed, 73 were retained. The literature analysis identified the following themes : 1) identity images of nurses during this pandemic and their professional roles ; 2) the sometimes paradoxical nature of media and political discourse ; and 3) the fact that this discourse seems to influence clinical nursing practice, which is being assigned new roles.Conclusion : This article raises awareness among decision-makers about the multiple roles of nurses and the public image of nurses during a pandemic, and takes a critical look at popular discourses related to nurses' identity and how this identity changes during a pandemic.

The question of how the mind works is at the heart of cognitive science. It aims to understand and explain the complex processes underlying perception, decision-making and learning, three fundamental areas of cognition. Bayesian Brain Theory, a computational approach derived from the principles of Predictive Processing (PP), offers a mechanistic and mathematical formulation of these cognitive processes. This theory assumes that the brain encodes beliefs (probabilistic states) to generate predictions about sensory input, then uses prediction errors to update its beliefs. In this paper, we present an introduction to the fundamentals of Bayesian Brain Theory. We show how this innovative theory hybridizes concepts inherited from the philosophy of mind and experimental data from neuroscience, and how it translates complex cognitive processes such as perception, action, emotion, or belief, or even the psychiatric symptomatology.

What is mood? Despite its crucial place in psychiatric nosography and cognitive science, it is still difficult to delimit its conceptual ground. The distinction between emotion and mood is ambiguous: mood is often presented as an affective state that is more prolonged and less intense than emotion, or as an affective polarity distinguishing high and low mood swinging around a baseline. However, these definitions do not match the clinical reality of mood disorders such as unipolar depression and bipolar disorder, and do not allow us to understand the effect of mood on behaviour, perception and cognition. In this paper, we propose a multidimensional and computational theory of mood inspired by contemporary hypotheses in theoretical neuroscience and philosophy of emotion. After suggesting an operational distinction between emotion and mood, we show how a succession of emotions can cumulatively generate congruent mood over time, making mood an emerging state from emotion. We then present how mood determines mental and behavioral states when interacting with the environment, constituting a dispositional state of emotion, perception, belief, and action. Using this theoretical framework, we propose a computational representation of the emerging and dispositional dimensions of mood by formalizing mood as a layer of third-order Bayesian beliefs encoding the precision of emotion, and regulated by prediction errors associated with interoceptive predictions. Finally, we show how this theoretical framework sheds light on the processes involved in mood disorders, the emergence of mood congruent beliefs, or the mechanisms of antidepressant treatments in clinical psychiatry.

Télévie and the Léon Fredericq Foundation support many research projects in the CHU of Liège and the ULiège. This paper summarizes some projects aiming at a better knowledge of the basic mechanisms leading to cancer development, of the immune defenses against tumours, of specific characteristics of some cancer types and, finally, of strategies for improving quality of life of patients whose fertility has been threatened by anti-cancer treatments.Le Télévie et la Fondation Léon Fredericq soutiennent de nombreux projets de recherche cancérologique au CHU de Liège et à l’ULiège. Cet article résume quelques projets de recherche qui concernent une meilleure connaissance des mécanismes fondamentaux qui sous-tendent la formation des cancers, des moyens de défense de l’organisme contre ces maladies, des caractéristiques particulières de quelques types de cancers et, enfin, de stratégies visant à améliorer la qualité de vie des patientes cancéreuses en leur rendant la fertilité menacée par les traitements anti-cancéreux.

Phenylketonuria is the most common inborn error of metabolism and causes irreversible mental retardation if left untreated. Its newborn screening was made possible by the technique of blood collection on filter paper developed by Robert Guthrie. Neonatal PKU screening began in France in the early 1970s. It was initially carried out by a bacteriological method, then by fluorometry, and finally, since 2020, by tandem mass spectrometry. More than 35 million newborns have been screened to date. This resulted in the diagnosis of more than 3,500 children with PKU or mild hyperphenylalaninemia. The management of these children has improved over time, in particular thanks to the techniques of biochemistry and molecular genetics which lead to an accurate diagnosis and the arrival of drug treatment by sapropterin. Thanks to this screening, which allows for early management, the prognosis of PKU has been transformed and, although neurological or behavioral problems may arise, these patients are living normally today.Le dépistage de la phénylcétonurie en France.La phénylcétonurie (PCU) est la plus fréquente des erreurs innées du métabolisme et entraîne un retard mental irréversible en l’absence de traitement. Son dépistage néonatal a été rendu possible grâce à la technique de recueil de sang sur papier buvard mise au point par Robert Guthrie. Le dépistage néonatal de la PCU a débuté en France au début des années 1970. Il a été initialement réalisé par une technique bactériologique, puis fluorimétrique et, enfin, depuis 2020 par spectrométrie de masse en tandem. Plus de 35 millions de nouveau-nés ont été dépistés à ce jour, ce qui a permis de diagnostiquer plus de 3 500 enfants porteurs de PCU ou hyperphénylalaninémie modérée. La prise en charge de ces enfants a évolué avec le temps, en particulier grâce aux techniques de biochimie et de génétique moléculaire qui permettent un diagnostic précis et grâce à l’arrivée d’un traitement médicamenteux par saproptérine. Grâce à ce dépistage, qui permet une prise en charge précoce, le pronostic de la PCU a été transformé et, même s’il peut survenir des problèmes neurologiques ou comportementaux, ces patients ont une vie normale aujourd’hui.

Metatarsophalangeal arthritis of the first ray of the foot, also known as hallux rigidus, is an invalidating cause of walking that is still underestimated. It is associated to a local deformation of the first ray with a limitation of the dorsal mobilization of the joint, affecting thus the propulsion of the foot. Several stages of the disease exist, and symptoms as well as the treatment will depend on the moment of the consultation. In this paper, we present the different clinical pictures and adapted treatments according to the stage of the disease, and we share our results of a new modality of surgery that conserves the articular mobility of the joint.L’arthrose métatarsophalangienne du premier rayon du pied, connue également sous le nom de « hallux rigidus », est une pathologie invalidante de la marche encore sous-estimée. Elle est associée à une déformation localisée du premier rayon et à une limitation de la flexion dorsale au niveau de l’articulation, affectant ainsi la propulsion. Plusieurs stades de cette maladie existent, et les symptômes ainsi que leurs traitements dépendront du moment de consultation. Dans cet article, nous présentons les différents symptômes et traitements de cette arthrose, adaptés selon le stade en partageant notre expérience avec les nouveautés technologiques conservatrices du mouvement articulaire et leur résultat à moyen terme.

One of the most problematic aspects of patients' quality of life after cancer is often the impacts on sexuality. Among the health care professionals (hcp) involved in care process, the important role that nurses could play, alongside with doctors, in dealing with these issues has been emphasized. However, it seems that hcp still struggling to broach this subject. The aim of this paper is to examine, based on current knowledge and, more specifically on a Swiss study, nurses' representations and practices facing such an issue in oncology. Findings highlighted that hcp were unequipped due to a lack of training and hampered by structural and personal constraints. Practical perspectives are suggested to allow future adjustments.

One of the most problematic aspects of patients' quality of life after cancer is often the impacts on sexuality. Among the health care professionals (hcp) involved in care process, the important role that nurses could play, alongside with doctors, in dealing with these issues has been emphasized. However, it seems that hcp still struggling to broach this subject. The aim of this paper is to examine, based on current knowledge and, more specifically on a Swiss study, nurses' representations and practices facing such an issue in oncology. Findings highlighted that hcp were unequipped due to a lack of training and hampered by structural and personal constraints. Practical perspectives are suggested to allow future adjustments.Les répercussions sur la sexualité constituent souvent l’un des aspects les plus problématiques de la qualité de vie après un cancer. Parmi les professionnel·le·s de santé impliqué·e·s dans le parcours de soins, il a été souligné le rôle central que pourraient tenir les infirmier·ère·s, aux côtés des médecins, dans la prise en charge de ces questions. Or, il semble qu’ils-elles peinent à aborder ce sujet. L’objectif de cet article est d’examiner, sur la base des connaissances actuelles et, plus particulièrement, d’une étude menée en Suisse, les représentations et pratiques des infirmier·ère·s face à l’abord d’un tel sujet dans le champ du cancer. Les résultats relèvent que ces soignant·e·s sont démuni·e·s du fait d’un manque de formation et entravé·e·s par des contraintes structurelles et personnelles. Des pistes permettant des ajustements sont suggérées.