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High-risk drugs, which are potentially a source of serious adverse reactions, are a major concern in healthcare establishments, particularly for geriatric patients, who often have multiple medications and co-morbid conditions. With a view to continuously improving the quality and safety of care, we have embarked on a proactive approach aimed at identifying, securing and improving the management of medicines at risk in geriatric wards., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

As part of their missions, firefighters are exposed to a multitude of risks that can impact their health. Sensitive to this health and safety issue, the departmental fire and rescue service of Seine-et-Marne has designed and deployed a doctrine of health and safety support in operation. The members of the sub-directorate of the departmental fire and rescue service are the main actors in this process. The implementation of health support for firefighters in response relies mainly on the firefighter nurse. Indeed, the latter is led to develop, beyond his nursing practice, skills related to the analysis of health risks and the deployment of preventive and curative actions on intervention., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Professor Marlene Freeman of Massachusset General Hospital's answer to the question "How should I prescribe valproic acid (for psychiatric disorders) to women of childbearing age?" is "Don't do it at all.", (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Radiation therapy (RT) is a key component of the management of elderly breast cancer patients. However, level I evidence in elderly patients is limited. Patient selection should include comorbidities and geriatric assessment. Advances in radiation planning and delivery are improving target coverage, reducing toxicity, and expanding treatment eligibility. Some alternative techniques, such as treatment in the lateral or prone position, may reduce the risk of toxicity. Shorter cycles of hypofractionated whole breast RT are safe and effective. In some cases, partial breast irradiation may be an option., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Chronic illnesses, such as diabetes, have an impact on the body, but also on the psyche, disturbing the body image of the child or adolescent. This must be integrated into their"growing up process". To this end, health care professionals specialising in these populations provide the most appropriate support during these periods of doubt and uncertainty., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Safe nursing staffing and patient safety are closely related. A systematic review of the literature was carried out, comparing the number of falls in elderly inpatients in medical-surgical wards with these staffing levels. A review of scientific articles, selected through a keyword search of several electronic databases, showed a direct, although not significant, association between improved nurse staffing and a decrease in the number of falls in elderly inpatients., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Plant features represent a modality of outdoor architecture that can be integrated into a project to take into account the particularities of patients and residents, and in particular those with cognitive disorders and risks of running away. The concept of a "plant-based security system" is an innovative and transposable prevention approach that reconciles the constitutional right to freedom of movement and security. A living concept illustrated by the Seilleraye EHPAD in Carquefou., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Domestic violence has numerous consequences on the victims' health. Supporting these victims means firstly being able to recognise the warning signs. Tools exist to facilitate the role of health professionals on the front line to screen for domestic violence and identify with the victims the gravity of their situation. Depending on the risks involved, it is sometimes important to let them make their own enlightened choices to help them regain confidence and independence., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

The protection of a healthcare facility means maintaining a permanent approach of alertness for everyone working there. The hospital security plan involves internal and external players (police and emergency services), and requires the regular sharing of information and training., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

It is difficult on a daily basis to reconcile security and freedom, particularly the freedom to come and go of residents in accommodation facilities for dependent elderly people, and more specifically in the protected sector. With the COVID-19 epidemic, everyone experienced the effects of the lack of freedom. This echoed what residents may experience on a daily basis in institutions, where their freedom is often abused. If the effects of confinement are beginning to be studied in the general population, what about the repercussions on residents already weakened by the disease? How did they experience it? The deprivation of freedom acts on our emotions, on our psyche, in different ways. We will certainly have to learn from this period, notably on the importance of feeling free even in an institution., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

The use of physical, as well as chemical, restraints is subject to a medical prescription. It is a medical decision, most often fortunately made as a team. Responsibilities are involved when it is implemented. It is necessary to know them, as well as it is essential to know the alternatives. A study of the caring perception of restraint of hospitalized patients with neurocognitive disorders and excessive ambulation has been carried out. Thus, an ethical approach would make it possible to adopt a fairer approach taking into account the notions of individual and collective freedom, safety and risk., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

A child's sleep is constantly changing. Many parents find themselves helpless when faced with children who have difficulty sleeping. Concrete tools can be implemented to help them. The role of caregivers is to accompany these families and to direct them with appropriate advice., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

The home is a unique place of practice for caregivers, with specific constraints linked, notably, to the environment. In addition to the well-known risks (infections, moving/lifting patients), the caregiver faces isolation and sometimes difficult emotional, social and environmental situations. The prevention of these situations requires continuing training and improved communication as well as appropriate tools and safety measures., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Virtual reality is an innovative solution in simulation when it is used to reinforce caregivers' skills. A health facility has set up a continuing professional development programme using this technique. It has enabled caregivers to reinforce their skills in the area of blood transfusion safety., (Copyright © 2019. Published by Elsevier Masson SAS.)

Certification Process of a Hospital at Home Facility: The certification visit by the French National Health Authority requires a high level of commitment and collaboration on the part of the teams of the healthcare facility concerned. Professionals from a hospital at home unit having obtained its Level A certification describe the process and explain how the approach helped to give meaning to collective action when caring for patients in their home., (Copyright © 2018. Published by Elsevier Masson SAS.)

PROGRAMME FOR THE CONTINUOUS IMPROVEMENT OF TEAM WORK TO IMPROVE THE SAFETY OF PATIENT CARE.: The analysis of the causes of care-related adverse events shows that in order to improve safety, human and organisational factors must be taken into account, and action taken to target team work. Based on this observation, the French National Health Authority designed and tested with volunteer teams the Programme for the Continuous Improvement of Team Work, between 2013 and 2016. This programme provides professionals with a series of tools and methods to improve they way they work in a team. Eventually, the implementation of the programme will be a requirement for the certification of healthcare facilities., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

The National Policy of Care Quality and Safety Indicators: Care quality and safety indicators, piloted by the national health authority, are tools forming part of a global programme of improvement of quality and safety of care. The national scheme for measuring the quality and safety of care provides, for all healthcare facilities, dashboards for managing care quality and safety. Currently focused on the public and private hospital sector, it needs to evolve to widen its scope to include community care and the medical-social sector., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Pre- and postnatal haptonomy constitutes a quality form of support for babies and their parents, from the final months of pregnancy through to the acquisition of walking. It contributes to the development of infants' emotional, sensory and tonic-postural security, enabling them to start to move and engage with confidence in life and in relationships., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Simulation in health care is a very effective training tool. Using mannequins, 'standardised patients' or virtual care environments, it encourages participants to reflect on nursing practices while practising in a safe and controlled space., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

By favouring the proximity of a caregiver, attachment is essential for enabling children to live and grow. It constitutes both an emotion regulator and an internal security base. It is a complex process which evolves throughout a person's lifetime., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Introduction: Attachment is a long lasting emotional link established between infants and their caregivers. The quality of early relationships allows infants to safely explore their environment and contribute to the establishment of a broad range of social skills. Several intervention programs targeting infant attachment have been implemented in different contexts, showing diverse degrees of efficacy., Objective: The present paper describes, for the first time, children's attachment quality distributions in a French multi-risk population, with a preventive intervention, usual or reinforced., Method: In the CAPEDP study (Parenting and Attachment in Early Childhood: reducing mental health disorder risks and promoting resilience), a sub-sample of 117 women was recruited to assess the effects of this home-visiting program on children's attachment security. With that intent, the Strange Situation Paradigm was used when infants were between 12 and 16 months of age., Results: In the intervention group, 63% (n=41) of the infants were coded as secure, while 15% (n=10) of them were coded as insecure-avoidant and 22% (n=14) as insecure-ambivalent/resistant. 56% (n=29) of control group infants (usual care) were coded as secure, while 27% (n=14) were coded as insecure-avoidant and 17% (n=9) as insecure-ambivalent/resistant. Even if the percentage of children with a secure attachment in the reinforced intervention group was higher than that of the control group, this difference did not reach the threshold of significance [Chi 2 (2)=2.40, P=0.30]., Discussion: Intervention group distributions were closer to normative samples, and these distributions show the clinical impact of our program. In general, preventive interventions focused on attachment quality have moderate effects but, in our case, several factors might have contributed to lower the statistical impact of the program. Firstly, the control group cannot be considered has having received zero intervention for two reasons: (a) the French usual perinatal health system (Maternal and Infant Protection System) is particularly generous and (b) the effect of this usual system might have been increased by the project intensive assessment protocol (6 visits during 28 months). Secondly, it is possible that the full effect of the intervention had not yet been detected because, when a child's attachment was assessed, only two thirds of the intervention visits had been performed (29 of 44 visits). A "sleeper effect" is still possible: we hope that a more clear result will be seen when children are assessed again, at 48 months, in our follow-up study (CAPEDP-A II). By clarifying the mechanisms involved in the development of a secure attachment, our study aims to contribute and refine the development of early preventive intervention strategies in high perinatal and psychosocial vulnerability contexts., (Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Simulation in health care helps to raise health professionals' awareness of medical ethics and to understand the mechanisms involved in a difficult situation. They can thereby adopt a suitable form of behaviour and communication., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Intimate partner violence has a significant impact on children, who are caught up in a conflict of loyalty with regard to their parents. Their development can be compromised in these situations. It is essential to meet the specific needs of these children, notably by enabling them to express their emotions, while providing them with a safe environment and adapted support., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

The medicine use pathway is a process which is constantly evolving in order to comply with intangible rules. As in other therapeutic fields, the drug regimen in paediatrics must tolerate no error and must be able to detect all warning signs, however minor, in order to optimise this approach., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

At the heart of the complexity of an organised system, the student must learn to manage situations presenting characteristics of known or potential risk. The trainer integrates it into an approach in which reflexive analysis and objectivity are essential in the professional practice., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Purpose: To describe a method of deep sedation without adjunctive periocular injection in phacoemulsification with a scleral tunnel technique., Methods: All patients undergoing phacoemulsification with a scleral tunnel and foldable intraocular lens for cataract between May 2011 and November 2014 received deep sedation including a bolus of midazolam and fentanyl followed by a continuous perfusion of dexmedetomidine throughout the surgical procedure. The patients and medical team evaluated pain, sedation, clinical status of the patient, and surgeon comfort., Results: One thousand and five hundred patients were included, representing 1763 eyes. Ramsay's sedation score was 2 in 7.13% of cases and 3 in 86.3%, which allowed surgery to be performed under very satisfactory conditions. On a scale of 1 to 10, intraoperative pain was less than or equal to 1 in 81.2% of cases. The bradycardic and hypotensive effects of dexmedetomidine were appreciable, while respiratory depression was not observed. Only 1 case of severe agitation during surgery directly resulted in a vitreous issue. Some simple precautions allow optimization of the advantages of this method of anesthesia., Conclusion: The deep sedation method including bolus injections of midazolam and fentanyl and continuous perfusion of dexmedetomidine affords a certain comfort to the patient as well as the surgeon in phacoemulsification of cataract through a scleral tunnel without adjunctive periocular injection., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

The operating room (OR) is a high-risk complex setting, where patient safety relies on the coordinated efforts of multiple team members. However, little attention has been paid to evaluating the strategies employed by OR practitioners to prevent and correct incidents that inevitably occur during surgery. Therefore, we were prompted to investigate human factor (HF) engineering methods that have been used in an innovative way in order to systematically observe and analyze the management of incidents in the neurosurgical OR of a French university hospital. A technical case report illustrates our approach that associates the following procedures: the recording of OR team member activities and behaviour by video cameras and direct observation of a HF researcher, with the description and the explicit demonstration of safety related procedures in self- and cross-confrontation interviews of OR team members. This technical report emphasizes complementary aspects of clinical performance related to safety skills. Moreover, individual and team performances rely on complementary abilities that associate practical knowledge, skills, and attitudes, which are engaged at various degrees to prevent and manage incidents. This report also enlightens new quality-improvement opportunities as well as further objectives for future studies., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)