Search

Background: Heart failure is a potentially life-threatening condition that disrupts the normal flow of blood throughout the body. Patients with heart failure lack sufficient knowledge regarding drug treatment adherence. An effective discharge plan and its continuity can improve treatment adherence.Aim: This study was performed with aim to compare two methods of discharge care program follow-up on drug treatment adherence of patients with heart failure.Method: This quasi-experimental was conducted in 2022-2023 on 126 patients with heart failure in Iran. Participants were divided into the two intervention groups via telephone call (group A), and via video message (group B) and a control group (group C). The required data were collected through Morisky Medication Adherence Scale (MMAS-8) before and 12 weeks after the start of the intervention. In the intervention groups, the care plan was presented to the patients every two weeks.Results: The mean drug treatment adherence scores increased to 2.47±1.68 in group A, 1.51±2.11 in group B, and 0.83±1.60 in group C, which was significantly different in each group and among the three groups (p

Cet article présente l'outil d'autoévaluation des émotions douloureuses (EED), un outil quantitatif et qualitatif conçu pour accompagner le proche dans le cadre du programme Ensemble qui propose des interventions personnalisées. L'EED comporte une partie de cotation de la fréquence des émotions douloureuses et de l'urgence du besoin d'aide vis-à-vis de celles-ci, suivie d'un échange pour définir les actions cliniques. Des données ont été collectées auprès de 73 proches de patients atteints de troubles psychiatriques. Les données démographiques, les scores de l'EED et les scores de l'inventaire bref des symptômes (Brief Symptom Inventory , BSI) sont collectés lors d'entretiens avec les intervenants du programme Ensemble. L'Impuissance et l'Anxiété sont des émotions particulièrement préoccupantes pour les proches aidants. Les analyses de validité montrent que la fréquence du ressenti des émotions douloureuses est un indice significatif de la détresse psychologique des proches aidants. Les scores obtenus avec l'EED peuvent orienter le suivi proposé par l'intervenant. Les bonnes propriétés psychométriques de l'EED et son utilisation simple en font un outil rapide à administrer et bien adapté à l'accompagnement sur mesure des proches aidants. Informal caregivers take on a variety of tasks to help their ill loved ones. Despite the personal and professional resources available, their health is sometimes impacted, and they may suffer from sleep disorders, chronic fatigue, and psychological distress. Supporting informal caregivers to prevent the risk of exhaustion entails a recognition of distressful emotions that can be associated with the role of caregiver. This article presents the Distressing Emotions Evaluation (DEE) tool, a quantitative and qualitative tool designed to support informal caregivers in the context of the Ensembl e program which proposes tailored and individualized interventions. Ensemble is independent of the patient's treatment and follow-up and its objective is to offer individual support to informal caregivers. It is structured in three phases spread over five one-hour sessions: an evaluation phase, followed by a support phase and finally an assessment phase. During the first phase, a professional trained in Ensemble 's methods assesses the needs, difficulties, painful emotions, and social resources of the informal caregiver. The DEE includes a rating scale, assessing the frequency of distressing emotions and the urgency of the need for help with dealing with them, followed by a dialogue to identify clinical actions. To assess the psychometric properties of the DEE, data were collected from 73 informal caregivers of patients with psychiatric disorders. The DEE tool consists of an inventory of cards illustrating eight distressful emotions: anxiety, anger, confusion, guilt, helplessness, feeling judged by others, loneliness, and sadness/distress. Demographic data, DEE scores, and Brief Symptom Inventory (BSI) scores were collected during interviews with Ensemble practitioners. Helplessness and anxiety are particularly distressing emotions for informal caregivers. Indeed, they are among the most frequently reported emotions (present for 88 % and 71 % of the participants, respectively), and are the emotions for which unmet need for help is the most urgent (in 49 % and 40 % of the participants, respectively). Validity analyses with reference to associations with BSI scores show that the frequency of experiencing distressing emotions is a significant indicator of the psychological distress of informal caregivers. DEE scores can inform a practitioner's follow-up, e.g., with tools for managing emotions. The positive psychometric properties of the DEE, and its simple use based on illustrated card sorting which facilitates verbalization, make it a tool that is readily administered and well suited to the personalized support of informal caregivers. Based on the EED tool, the results demonstrated that helplessness and anxiety are very frequent painful emotions for informal caregivers and that there is a need for help that is not currently met by existing support services. The engaging clinical EED tool makes it easier to work with informal caregivers. This approach can be used to increase health literacy in personalized interventions focused on the recovery paradigm. [ABSTRACT FROM AUTHOR]

La clozapine est le traitement de référence dans la schizophrénie résistante. Cette molécule, bien qu'ayant prouvé son efficacité dans de nombreuses études, reste largement sous-prescrite dans son indication principale. La réalisation de programmes d'éducation thérapeutique du patient (ETP) centrée sur cette molécule pourrait permettre, d'une part, de favoriser la prescription de cette molécule et, d'autre part, de favoriser l'adhésion thérapeutique des patients à ce traitement via une meilleure connaissance de celui-ci. Cet article présente le programme d'ETP « Vivre avec la clozapine » élaboré pour l'initiation et le suivi des patients sous clozapine. Clozapine is the reference treatment for resistant schizophrenia. Although its efficacy has been widely demonstrated in numerous studies, it remains largely under-prescribed in its main indication. Therapeutic patient education (TPE) programs focused on clozapine could, on the one hand, promote the prescription of this drug and, on the other, encourage patients to adhere to the treatment schedule by improving their knowledge of its effectiveness. This article presents the TPE program entitled " Living with clozapine " developed to support the initiation and follow-up of patients being treated with clozapine. [ABSTRACT FROM AUTHOR]

Bipolis® est un programme d'éducation thérapeutique du patient, destiné aux personnes souffrant de troubles bipolaires, construit et mis en place par le docteur Barbara Combes. Nous avons étudié son impact sur les récidives du trouble bipolaire, sur la qualité de vie perçue, ainsi que sur le degré de satisfaction des patients pour la participation au programme BIPOLIS®. Notre travail constitue une enquête rétrospective, concernant des patients bipolaires pris en charge en éducation thérapeutique avec le Programme d'éducation thérapeutique du patient (PETP) Bipolis® (groupe Exposé) entre mars 2009 et juillet 2017, comparés à un échantillon de témoins appariés sur le sexe, l'âge et l'année de début de suivi au centre de consultation, qui n'a pas suivi de PETP Bipolis® (groupe Non Exposé). La prise en charge avec le PETP Bipolis® chez ces patients n'est pas exclusive et ne se substitue pas aux autres modes de prise en charge conventionnels. C'est pourquoi l'ensemble des patients des groupes Exposé et Non Exposé bénéficie d'un suivi médical pour leur pathologie bipolaire au sein ou à l'extérieur du CHG Marchant à Toulouse. Cette étude consiste en l'analyse des données contenues dans le dossier médical des patients et en la passation d'un questionnaire téléphonique. Nous avons inclus 55 patients dans le groupe Exposé et 50 dans le groupe Non Exposé. Notre étude permet d'établir significativement un lien entre Bipolis® et le nombre d'hospitalisations dans les deux ans, puis les cinq ans qui suivent la fin du programme. Nous observons, en effet, une diminution de 80 % des hospitalisations contraintes, sous la forme d'Admissions en Soins Psychiatrique à la Demande d'un Tiers (ASPDT) dans les deux ans qui suivent la fin du programme. Dans les cinq ans qui suivent la fin du programme, nous constatons que la réalisation du programme Bipolis® est associée, de façon significative, à une diminution globale des hospitalisations (toutes catégories confondues) et plus précisément de 41.17 % des hospitalisations en Hospitalisation Libre (HL), mais aussi à une diminution de 34,62 % des déstabilisations prises en charge en ambulatoires. Ces résultats sont à relier à l'amélioration du ressenti par les patients de leur état de santé psychique et physique, à la compréhension et l'acceptation du traitement et enfin à la connaissance des stratégies non médicamenteuses complétant l'objectif de stabilisation. Bipolis® permet aussi aux patients de se sentir moins limités dans la réalisation de tâches domestiques, la création de lien social, l'accès à des loisirs et à la mise en place de projets. Il diminue aussi les difficultés ressenties par les patients sur le lieu de travail. Bipolis® permet à court terme de diminuer la gravité des hospitalisations ; en effet dans les deux ans après la fin du programme, on retrouve une diminution de 80 % des ASPDT dans le groupe Exposé par rapport au groupe Non Exposé. À plus long terme, soit dans les cinq ans, ce programme réduit le nombre des hospitalisations qui suivent la fin du programme et particulièrement le mode d'Hospitalisation Libre (HL). Les déstabilisations ambulatoires sont de même diminuées sur la même période. Ce programme est aussi associé à l'amélioration de la qualité de vie des patients. Bipolis® is a therapeutic patient education program for people with bipolar disorders from healthcare institutions in the Occitania region, designed and implemented by Dr Barbara Combes. This program is based on the SARA® method (Ambulatory Recovery Assistance Internship), four independent and complementary sub-programs. This innovative therapeutic and pedagogical approach incorporates therapeutic knowledge in four areas of activity (Appropriation of the disease, Relapse, Sociality, Hygiene of Life) and invests the working postures of the patient and the specific professional ETP caregiver. It adopts original ETP techniques in "common axes of strength" in each SARA ® sub-program to understand psychic functioning, address states of stability and instability, and the fundamental problems of psychiatric pathology. A Free Enrolment Modality was used depending on the patient's desire to learn skills, self-care strategies and adaptive strategies. We explored its impact on the recurrences of bipolar disorder, the degree of patient's satisfaction and the perceived quality of life. Our work constitutes a retrospective survey of cohort exposed versus non-exposed research, whose target population is patients with bipolar disorder who participated in Bipolis® between March 2009 and July 2017, with whom we have compared a sample of controls based on gender, age, and the year of the beginning of follow-up at the counselling center who did not participate in the Bipolis® program (non-exposed group). Our study consisted of analyzing the data contained in the patients' medical files and conducting a telephone questionnaire. We included 55 patients in the exposed group and 50 in the non-exposed. The primary endpoint is the number of psychiatric hospitalizations occurring at 2 years and at 5 years following the index date. The index date (T0) is the end date of participation in the 4 SARA® sub-programs of Bipolis® for the exposed patients. Our study established a significant link between Bipolis® and the number of hospitalizations at either 2 or 5 years following the end of the program. In effect, at 2 years after the program (involuntary admission in psychiatric care at the request of a third party) we observed an 80 % decrease in ASPDT hospitalizations. In the 5 years following the end of the program, we noted that the implementation of the Bipolis® program is associated with an overall decrease in hospitalizations (all categories combined) and more precisely a drop of 41.17% in voluntary hospitalizations. As for the results regarding the impact of Bipolis® on destabilizations treated on an outpatient basis, we find, however, that within 2 years, they are fewer in number but the differences are not significantly conclusive. Whereas at the 5-year mark following the end of the program, there is a 34.62% decrease in destabilizations for those patients in outpatient care. We can therefore hypothesize that, surprisingly, Bipolis® seems to provide better protection from outpatient relapse at 5 years, than at 2 years. Several hypotheses can be suggested : in the first place, 31% of the Bipolis® patients we included participated in at least one other SARA® program and therefore did more than 4 SARA® programs, or at least one SARA®, after their T0 when they personally felt the need for reinforcement. The results of the questionnaire show that Bipolis® improves the patients' perception of their mental and physical health. 93.1% of patients found that Bipolis® helped them in understanding and accepting treatment, and 85.7% of the patients were able to identify complementary non-medicinal strategies and to distinguish between them and chemical treatments. Bipolis® allows patients to feel less limited in carrying out domestic tasks, establishing social links, participating in leisure activities or setting up projects. It also reduces the difficulties experienced by patients in the workplace. Bipolis® reduces the severity of hospitalizations: in fact, 2 years after the end of the program, there is an 80% reduction in ASPDT hospitalizations in the exposed group compared to the non-exposed Bipolis® group. In the long term, this same program reduces the number of hospitalizations at 5 years following the end of the program and particularly for voluntary hospitalizations. Outpatient destabilizations are also reduced over the same period. This program is also associated with an improvement in the patients' quality of life. [ABSTRACT FROM AUTHOR]

Mechanical bowel obstruction is a common symptom for admission to emergency services, diagnosed annually in more than 300,000 patients in the States, from whom 51% will undergo emergency laparotomy. This condition is associated with serious morbidity and mortality, but it also causes a high financial burden due to long hospital stay. The EUPEMEN project aims to incorporate the expertise and clinical experience of national clinical specialists into development of perioperative rehabilitation protocols. Providing special recommendations for all aspects of patient perioperative care and the participation of diverse specialists, the EUPEMEN protocol for bowel obstruction, as presented in the current paper, aims to provide faster postoperative recovery and reduce length of hospital stay, postoperative morbidity and mortality rate. [ABSTRACT FROM AUTHOR]

LIVIA est une intervention psychologique par Internet en dix modules sur une durée de trois mois pour personnes présentant une souffrance psychique après la perte de leur partenaire par décès, séparation ou divorce. Traduite d'un programme allemand dont l'efficacité a été démontrée par une étude randomisée contrôlée, la version française de LIVIA a été proposée en Suisse romande, en version non guidée, dans le cadre d'une étude d'implémentation pilote visant à en vérifier l'accueil. Sur 148 personnes inscrites suite à une présentation du programme dans des journaux ou à la radio, 24 ont participé intégralement à l'essai clinique et ont fourni les mesures de prétest et posttest sur leurs symptômes de deuil, d'anxiété et de dépression, leurs modes d'adaptation à la perte, leur support social, leur sentiment de solitude ainsi que leur bien-être. Elles ont pu également exprimer leur degré de satisfaction vis-à-vis du programme et formuler des commentaires à son sujet. La médiane de participation au programme est de six modules : dix personnes ont réalisé neuf à dix modules, cinq ont accompli moins de la moitié des séances prévues. Des bénéfices significatifs ont été observés sur les symptômes de deuil et sur les stratégies d'évitement. Aucune autre amélioration n'a été relevée sur la symptomatologie dépressive, anxieuse, sur le bien-être, la satisfaction existentielle ou encore la solitude. La satisfaction vis-à-vis de l'intervention est globalement bonne. Néanmoins, quelques points négatifs ont pu être relevés : les textes explicatifs ont été jugés complexes et les exercices de confrontation plutôt pénibles, surtout en l'absence de soutien d'une personne ressource. Ceux-ci ont pu favoriser la diminution de l'engagement dans le programme. LIVIA, dans sa version française non guidée, permet de réduire la symptomatologie du deuil et les stratégies d'évitement suite à un décès ou une séparation. Le programme mérite cependant des améliorations pour satisfaire un public plus large et améliorer son adhésion à la démarche. The loss of a partner, either by death or separation, is one of the most stressful life events. It predicts negative physical and psychological health consequences. Although most people are able to cope with it, however about ten percent show difficulties overcoming this painful event. Internet psychological interventions are increasingly present. They are as effective as traditional psychotherapies for a wide range of disorders, including complicated grief. They can improve the access to treatment, particularly where availability of therapists is low. Without such access the mental health of people with serious bereavement or separation difficulties, who for various reasons cannot benefit from a mental health professional, may deteriorate. Early access to an online intervention can thus be a useful and alternative way to diminish the risk of psychopathological trajectory for them. The goal is to evaluate the implementation of LIVIA, an unguided Internet-based intervention for French-speaking people struggling to cope with the loss of their partner through bereavement, divorce or separation. Brodbeck and colleagues have demonstrated its efficacy in the German guided version. In this non-randomized clinical trial, 24 participants were included. They completed the French version of LIVIA, which contains ten modules including a psychoeducational section and exercises based on cognitive-behavioral techniques. The evolution of psychopathological symptoms such as grief, anxiety, and depression, as well as well-being were evaluated. Other parameters were measured: avoidance strategies, social support, loneliness and satisfaction regarding the program. The median of program participation is six modules: ten people completed nine to ten modules, five completed less than half of the planned sessions. Clinical benefits were observed on grief symptoms and avoidance strategies. No other improvement was noted on depressive symptomatology, anxiety, well-being, life satisfaction or loneliness. The overall satisfaction with the intervention was good. Nevertheless, some negative points were noted: the explicative texts were considered to be complex and the confrontation exercises rather difficult, especially without the support of a resource person. These points could lead to a decrease in commitment to the program. LIVIA, in its unguided French version, helps reduce grief symptoms and avoidance strategies following a death or separation. However, the program needs to be improved in order to satisfy a broader public and improve its adherence to the intervention. [ABSTRACT FROM AUTHOR]

Tea for the Soul (TFS) is an understudied care model, addressing bereavement and other emotional needs of nurses related to impactful patient care experiences. Nurses are at high risk for compassion fatigue, moral distress, and burnout. Facilitated by a Chaplain, the TFS program provides participants a venue to express their feelings and explore ways of adapting effectively with the death of a patient, and other traumatic workplace experiences. In this qualitative grounded theory study, hospital nurses (N = 7) who participated in TFS were interviewed. IRB approval was obtained. Questions were constructed within the context of the medical center research council and asked if TFS: (a) was personally beneficial, (b) helped nurses feel better about their work, and (c) affected job satisfaction. Four core themes emerged: (a) Nurses' Self-Care, (b) Professional Practice, (c) Community, and (d) Improved Patient Care Outcomes. The Roy Adaptation Model, Group Identity Mode was applied to the content analysis. Overarching themes were Compassionate Service, Ministry of Presence, Reflective Practice, and Sacred Encounters. Nurses reported that TFS facilitated a spiritual respite and a sense of enhanced community and was a source of strength and coping, thus may aid in the promotion of nurse well-being and the amelioration of moral distress, compassion fatigue, and burnout. [ABSTRACT FROM AUTHOR]

Objectives: The birth of a premature baby can change all the emotions of parents and replace stress. It is necessary to identify the factors that aggravate and relieve maternal stress and adopt strategies to reduce it. The aim of this study was to analyze the effect of supportive care program based on Bandura’s self-efficacy on aggravating and stress relieving factors of mothers of neonates admitted to the neonatal intensive care unit Methods: A quasi-experimental study was performed in 2020 on 90 mothers of premature infants admitted to the neonatal intensive care unit of a Hospital in Shahrekord by convenience sampling method. The experimental group has received an educational intervention based on the theory of self-efficacy in four two-hour sessions with the presentation of an educational booklet. Data were collected using a self-designed questionnaire before and after the intervention in both groups and were analyzed using SPSS software version 24 performing paired t-test, independent t-test, and Chi-square. Results: The results showed that the mean score of stressors in mothers of preterm infants in the control group decreased from 42.73 ± 6.26 to 42.62 ± 7.09, which was not statistically significant (P= 0.906) while in the experimental group it was decreased from 48.78 ± 4.36 to 25.33 ± 4.84, which was statistically significant (P

Nous avons évalué la sévérité des troubles alimentaires de patients en surpoids avant et après un programme de soins pluridisciplinaires, chez des patients suivis entre 2016 et 2018. Le programme comportait quatre volets : psychothérapie comportementale, psycho-nutrition, kinésithérapie et activité physique adaptée. L'objectif principal était d'observer les modifications du « Three Factors Eating Questionnaire » (TFEQ) avant et après le programme. Cent soixante-huit patients, dont la majorité avait des compulsions alimentaires (65,5 %), ont poursuivi l'intégralité du programme. Après intervention, le score moyen du TFEQ avait diminué (p < 10−4), et ce de manière plus marquée chez les patients hors parcours de chirurgie bariatrique que chez les patients opérés ou en attente de chirurgie. Les facteurs F2 (désinhibition) et F3 (faim) ont également diminué, bien que le facteur F1 (restriction) n'était pas modifié, indépendamment de la prise en charge chirurgicale et de l'IMC. La sévérité des troubles alimentaires a diminué après le programme sur les compulsions et la perception de la faim. Chez certains patients la diminution de la restriction pouvait induire une augmentation des ingestas. Ce type de programme pourrait être étendu à tous les patients en surpoids. There is a growing need to build healthcare program addressed to overweighed and obese people suffering from eating disorders. The program named "Surpoids Objectif Forme Training" (SOFT) is dedicated to eating disorders care in overweighed people. In this study we wanted to assess severity of eating disorder before, and after the intervention with measuring Three Factors Eating Questionnaire (TFEQ) score in all patients who attended the program between years 2016 and 2018. SOFT is a multidisciplinary intervention organised for outpatients in Hospital La Casamance located in Aubagne, France. For each SOFT intervention lasting 10 weeks, patients were attending 40 sessions: 10 sessions in cognitive therapy in order to understand compulsive eating and to increase emotions skills (to recognize and to face emotions) and alternative behaviours; 10 sessions in psycho-nutrition with working on cognitive flexibility, connection to present and to senses (mindful eating) and recognizing sensations of hunger and satiating; 10 sessions of physiotherapy to get aware of body needs with hypopressive gymnastics and proprioceptive training; 10 sessions in adapted physical activity to encourage daily moderate physical activity and to introduce changes in patients way of living. This study was a prospective cohort study, in which we included all overweighed adults patients suffering from compulsive eating disorder including binge eating disorder and night eating syndrome. We wanted to assess TFEQ score before and after the program. We also measured Body Mass Index (BMI), bioelectrical impedance (muscle and fat mass), waist and hip circumferences, waist-hip ratio, endurance with 6 minutes walking test and muscle strength. Two hundred and one patients were included and 168 followed the entire program. The average BMI in our group was 35 kg/m2. Less than 25% of patients were suffering of binge eating disorder but most of patients had compulsive eating (65%). More than 50% of them had a TFEQ score higher than 25 before entering the program (average TFEQ was 25.2). After the program average TFEQ score had decreased from 25.2 to 20.0 (P < 10−4), with only 17.9% of patients with a TFEQ score above 25. These results showed improvement of severity of eating disorders with our multidisciplinary intervention. The cognitive restraint factor (F1) was not significantly decreased after intervention (P = 0.884), but disinhibition factor (F2) and hunger factor (F3) were significantly decreased (P < 10−4 for both) showing less compulsive behaviours and better hunger perception. BMI was also decreased after the intervention from 35.8 to 35.5 (P = 0.003). Waist hip ratio decreased from 0.86 to 0.85 (P = 0.002) but muscle and fat mass were not significantly changed. Physical activity parameters were also improved, with 586 meters distance in 6 minutes walking test instead of 499 meters (P < 10−4) and 30 repetitions instead of 25 (P < 10−4) in one minute sit-to-stand test. Most of patients were female, usually more frequent in eating disorders patients. More than 65% of patients had compulsive disorders without BED, which shows probably numerous atypical forms. Severity of eating troubles was decreased after intervention in disinhibition and perception of hunger, but cognitive restriction was increased in some patients, probably because they were trying to lose weight during SOFT program. In the same way, despite of a significant loss of weight, there was no change in muscle and fat mass proportions after intervention. By the way reducing restriction was sometimes inducing increase of intakes in some patients, and as a result no change observed in average body fat mass and muscle mass. After intervention we also noticed that waist circumference, hip circumference and waist-hip ratio were significantly decreased, probably thanks to physical activity targeting posture and improving global physical condition. We observed also best performances in muscle strength (sit to stand test) and in endurance (6 minutes walking test). Main limitations in this study were: a non-randomized non controlled study design; lack of long term assessment (which is very important for maintaining weight and avoid medical complications of overweighting) and no assessment of patient's quality of life after intervention as we think this is a great part of motivation to maintain long term changes of way of life. Despite these limitations, we hope that this program could be extended to all patients suffering from obesity and eating disorders with efficiency on eating behaviour. Changes in eating behaviour and in physical activity seem to be the first step to maintain weight at a long term perspective. [ABSTRACT FROM AUTHOR]

Autism spectrum disorders (ASD) are neurodevelopmental disorders of varying intensity and disability. The reference health strategy in France for the care of young children with autism is day care hospital (DCH). As the number of places in DCH is insufficient, medically coordinated care programs by the mental health consultation centers (MHCC) are being developed in response., Objectives: Our objective is to evaluate the effectiveness of a medically coordinated care program in a MHCC versus the care in DCH of child psychiatry., Methods: Non-inferiority retrospective study comparing the evolution after one year of care of 20 ASD children divided into two groups DCH and MHCC. In the DCH ASD group, the child is taken care of two half-days a week in a day hospital with individual educational care. In the MHCC ASD group, the child benefits from a medically coordinated care program. The medical care is reinforced by more frequent and longer consultations with guidance offered to parents. In both groups, the child receives speech therapy and psychomotor therapy in private practice at the same rate. Comparison is made using a composite criterion associating CARS-2 and VABS-II. Non-inferiority of the medically coordinated care program in autism in reference to DCH was tested on the difference between the changes (DCH group variation - MHCC group variation) with a non-inferiority threshold of 10% of the initial value of each score., Results: We observed a reduction in autism severity at the CARS-2 and a moderate improvement in socio-adaptive behavior at the VABS-II in both groups. This trend was even more pronounced in the MHCC group than in the DCH group, but only the greater reduction in CARS-2 severity in the MHCC was statistically significant., Conclusions: As it is necessary to integrate the two scales into the composite criterion, it is not possible to retain the non-inferiority of the MHCC with care program. However, both those children followed in DCH and those in the MHCC care program progress. This shows the relevance of the care offered at the MHCC for children suffering from ASD, in the context of a growing lack of space in DCH. The continuation of this research work through multicenter studies with larger numbers could demonstrate the non-inferiority of coordinated care programs in the MHCC versus DCH. It would also allow subgroups to be set up, taking into account the initial characteristics of the children in order to have more precise indications concerning the relevance of each treatment., (Copyright © 2024 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

LUTD is one of the possible factors influencing pediatric kidney graft outcomes. This study evaluates the results of a thorough assessment of voiding behavior in pediatric transplants. Data of patients with kidney disease of nephrological origin are compared to those with urological origin. A single‐center analysis of pediatric kidney transplants performed from 2005 to the present was executed. Donor and recipient characteristics as well as voiding and drinking habits were documented using FVCs and uroflowmetry with PVR measurements. LUTD was defined by a mean MVV >150% or <65% of the EBC for age, abnormal uroflowmetry, PVR repeatedly >15% of EBC or >20 mL, abnormal voiding patterns or behavior, and presence of LUT symptoms. LUTD was diagnosed in 71% of the 56 screened children and more present in urological origin of kidney disease (100%) compared to nephrological origin (61%, P =.005). Individual presence of LUT symptoms, abnormal voiding behavior, FVC parameters, UTIs, and uroflowmetry/PVR parameters were not different between the two groups. Polyuria after transplantation was seen in 63% of patients, mainly in the first post‐transplant years and recipients aged <10 years. Time after transplantation was a significant independent predictive factor for the presence of LUTD. LUTD is common in all pediatric kidney recipients and underestimated in those with a nephrological origin of disease. Active screening, monitoring and a care attention plan prior to transplantation and during follow‐up, is advocated to optimize outcomes for all patients. [ABSTRACT FROM AUTHOR]

Le but de cette étude pilote était de tester la faisabilité et l'acceptabilité de la version française d'un programme animé par des pairs sur le dévoilement à autrui d'informations sur sa maladie pour des personnes atteintes de troubles psychiatriques. Honnête, ouvert, prêt (HOP) est un programme court qui invite les participants à échanger sur la problématique du dévoilement de la maladie psychique. Trente et une personnes souffrant de troubles psychiatriques ont été recrutées dans trois institutions psychosociales pour tester ce programme. Les résultats montrent que le programme est faisable et acceptable pour les participants. La participation aux sessions pourrait conduire à une réduction de l'auto-stigmatisation. Le programme HOP offre une opportunité aux personnes atteintes de troubles psychiques d'échanger et de réfléchir sur le dilemme du dévoilement de la maladie psychique. This pilot study aims to assess the feasibility and acceptability of a short program about disclosure of mental illness for people with psychiatric disorders. The participants with a diagnosis of a severe psychiatric disorder were recruited in three psychosocial institutions in French-speaking Switzerland to attend 4 one-hour group sessions of the program Honest, Open, Proud. The sessions were led by a peer practitioner and a psychiatric nurse, using the program guide and the exercise manual shared with the participants. These documents were developed by the team of Patrick Corrigan and are available online. Session 1 invites the participants to consider the advantages and disadvantages of disclosing a mental illness. The costs and benefits are also put into perspective according to different contexts and the potential short- and long-term consequences. Session 2 presents different ways to disclose, from social avoidance to openly spreading one's experience. Session 3 allows participants to learn how to tell their own story. One month after session 3, participants attend a recall session to review their intentions to disclose or not after attending the program and if they have done so, talk about this experience. Self-stigma was measured with the Internalized Stigma of Mental Illness scale, comprising five dimensions; alienation, stereotype adherence, perceived discrimination, social withdrawal and resistance to stigmatization. Acceptability of the program for participants was measured by a 11-item self-reported questionnaire, open questions, attendance rate and drop out. Feasibility was assessed through its operational (training, accessibility, human resources), economics and legal (translation rights ethical considerations) dimensions. The results are based on data from a sample of 31 participants, aged 43 on average (SD 11.85) with a disease duration of 12.3 years (SD 8.77). The participation rate for HOP sessions was at 93.5%. Most of participants (23/29) attended all sessions, five participants attended three sessions and two participants attended two sessions. Most of participants (84%) appreciated the facilitation by a mental health peer practitioner and having the opportunity to talk about something they could not address elsewhere (73%). For 92% of them, elements of HOP could be applied in their daily lives and all are unanimous when recommending HOP to other people with psychiatric disorders. The HOP program is designed to be facilitated by peer practitioners, yet in Switzerland, their number and integration into care settings is still limited. The program has been feasible with a peer-practitioner only, in three institutions. The program is available freely for peer-practitioners and without cost for the participants and was adapted to the cultural context and was led in four sessions. It was accepted by the ethical committee for human being research and the original authors gave the right to translate it into French. Participants ask for a longer intervention with more practical exercises. In pretest, the average self-stigmatization score for the sample was 2.10 (SD 0.40), with a theoretical maximum of 4. The sub-dimension alienation shows an average score (2.32, SD 0.58) higher than the others. sub-dimensions, and adherence to the stereotype the lowest average score (1.87, SD 0.38). In post-test, the total self-stigma score decreased by 0.16, an average of 1.94 (SD 0.41). All the means of the sub-dimension scores also decreased, most importantly for the alienation (0.267). Internalized Stigma of Mental Illness scale total score was significantly improved at post-test (t(22) = 2.08, P = 0.049). This pilot study shows that the HOP program is acceptable and feasible for people with mental health disorders and achievable in psychosocial institutions. The results at the self-stigma scale show a reduction of self-stigma total score. [ABSTRACT FROM AUTHOR]

La prise en charge de la prééclampsie est bien codifiée en phase aigüe, mais le devenir des patientes en post-partum l'est bien moins. Pourtant, la prééclampsie est associée à un excès de risque de morbimortalité cardiovasculaire au long cours. Un parcours de soin a été créé au Centre Hospitalier Universitaire de Nantes pour évaluer à distance de l'accouchement les facteurs de risque cardiovasculaires des patientes ayant présenté une prééclampsie. Notre étude en présente les premiers résultats. Nous avons inclus 134 patientes entre octobre 2016 et janvier 2019 qui ont présenté une prééclampsie dans la région nantaise et qui ont bénéficié de ce dépistage dans l'année suivant leur accouchement. L'hypertension artérielle était persistante chez 28 patientes (20,9 %). Trente-quatre patientes étaient obèses (25,3 %) et un diabète a été diagnostiqué chez une patiente. L'hypertension artérielle était à prédominance diastolique, légère et dans plus d'un tiers des cas masquée (35,7 % de pression artérielle normale lors de la consultation mais élevée sur les mesures à domicile). Une hypertension artérielle secondaire (cause hormonale ou rénale) a été identifiée dans un tiers des cas (32,1 %). L'hypertension survenait plus souvent chez les patientes plus âgées (OR : 2,26 ; IC 95 % : 1,25- 4,11, p = 0,072), originaire d'Afrique sub-saharienne (OR : 11,52 ; IC 95 % : 2,67- 49,86, p = 0,01) et multipares (OR : 7,82 ; IC 95 % : 1,15- 53,21, p = 0,035). Ce parcours de soins permet donc de dépister et de prendre en charge précocement les facteurs de risque cardiovasculaire de ces jeunes femmes. The medical treatment of preeclampsia is well structured in its acute phase but the required follow-up with patients in post-partum is discussed. However, preeclampsia is associated with an increased risk of cardiovascular morbi-mortality in the long term. In order to optimize the post-partum treatment, a care program has been developed for these patients in the city of Nantes, France. This includes a check-up of the cardiovascular risks at a day hospital. Our study presents the first results of this program. The study included 134 patients who were diagnosed with preeclampsia between October 2016 and January 2019 in the Nantes area, France, and took part in the program within the year following their childbirth. A descriptive analysis was first carried out and then a multivariate logistic regression model was used to investigate the risk factors for persistent high blood pressure after preeclampsia. The study detected 28 cases of persistent hypertension (20.9%), 34 cases of obesity (25.3%) and 1 case of diabetes. Hypertension was predominantly diastolic, mild and sometimes masked (35.7%). In a third of the cases (32.1%), the hypertension was secondary. High blood pressure was found to be more frequent in older patients (OR: 2.26; 95% CI: 1.25-4.11, p = 0.072), patients from sub-Saharan Africa (OR: 11.52; 95% CI: 2.67-49.86, p = 0.01) and multiparous patients (OR: 7.82; 95% CI: 1.15-53.21, p = 0.035). The study confirmed that this care program enables an earlier detection and therefore treatment of the cardiovascular risk factors of these young women. [ABSTRACT FROM AUTHOR]

BACKGROUND: Surrogacy has become an alternative family formation option for women who are unable to carry a pregnancy. There is no comprehensive care program despite the different nature of this pregnancy. The present study aimed to develop a reproductive health-care program for surrogate mothers within the cultural and social context of Iran. MATERIALS AND METHODS: In the present sequential exploratory mixed methods study, first through a qualitative approach surrogate mothers, care providers, and policy makers of reproductive health services were selected purposefully. Data were collected by using the in-depth semi-structured interviews and analyzed. A care program draft was designed by integrating results of the qualitative study and reviewing the literature and guidelines, then appropriateness of each proposed care was assessed by a two-Rounds Delphi technique (RAM), and the final reproductive health-care program for surrogate mothers was developed. RESULTS: The surrogate mothers' reproductive health needs were summarized in four main categories: surrogate mothers' extra care, educational training, psychological support, and protecting against surrogacy's social and familial consequences. The reproductive health-care program for surrogate mothers were developed in four sections: prepregnancy health screenings and legal counseling; special care during embryo transfer until pregnancy confirmation; psychological support and prenatal care of surrogacy until delivery and follow-up postpartum care. CONCLUSION: Women face many challenges in surrogacy and need special care such as legal counseling, reproductive health care, and psychological support. Implementation of this care program seems to help improve the reproductive health of these mothers.

L'objectif de cette recherche est d'évaluer chez des hommes auteurs de violences conjugales les changements intrapsychiques apportés par une prise en charge encadrée par des professionnels. La méthodologie repose sur l'administration de questionnaires relatifs à trois caractéristiques du fonctionnement psychologique de l'individu (alexithymie, dépression et impulsivité) avant le début de la thérapie en groupe de responsabilisation (T1), et à son terme (T2). Des 56 hommes ayant participé au T1, 24 ont accepté de finaliser le protocole de recherche. Les résultats indiquent une diminution de l'alexithymie et de la dépression au sein de l'échantillon. L'impulsivité reste, quant à elle, stable dans le temps. Il semble donc nécessaire d'accompagner les auteurs de violence à développer leur capacité à se représenter leurs états émotionnels ainsi que de les comprendre pour les aider à mieux réguler leur comportement. The aim of our research was to examine the association between impulsivity, alexithymia and depression and the perpetration of physical and psychological intimate partner violence. We focused on these particular psychological characteristics in order to understand this phenomenon and its prevention and/or treatment. Our initial study of fifty-six male perpetrators showed domestic violence was associated with a high level of alexithymia and depression. Analyses showed they reported more depressive feelings, and more difficulties to express their emotions than did general population. To determine if reductions were noted about these psychological characteristics at the end of intervention program, the present study examined longitudinal data. Twenty-four male offenders (voluntary or judicialized) were surveyed using self-report questionnaires and structured clinical interview to collect sociodemographic data and to assess specific psychological variables, namely emotional distress (Beck Depression Inventory), impulsive behavior (Barratt Impulsivity Scale 11) and alexithymia (Toronto Alexithymia Scale 20), the inability to experience and express subjective emotions. These men were examined before the start of therapeutic program (T1) and at the end of it (T2), after 42 hours of psychological support. Findings showed both alexithymia and depression were reduced after therapeutic management. Analyses showed male intimate partner violence offenders reported less difficulty to express their emotions and less depressive feelings at the end of their intervention program. However, we only observe a significant result for alexithymia and its dimension "difficulties identifying feelings". Impulsivity, on the other side, remains unchanged between the two evaluation times for all participants after the therapeutic program. Our findings suggested a strong link between alexithymia and domestic violence and showed the positive effect of specific therapeutic interventions on alexithymia and depression. We pointed out the fact that with the decrease of alexithymia, participants may have a better awareness of themselves and of their behavior. In conclusion, it is encouraging to note that specific treatment programs increase awareness about the problem of intimate partner violence. [ABSTRACT FROM AUTHOR]

Amorcée à la fin des années 1950, la désinstitutionnalisation psychiatrique américaine a pour but de réinsérer les patients dans la communauté. Dans un contexte pénal répressif et du fait de changements de caps politiques, les personnes qui souffrent de troubles mentaux les plus sévères se retrouvent surreprésentées dans le système judiciaire. Dans les années 1990, le gouvernement se saisit de cette situation et développe des programmes de déjudiciarisation parmi lesquels les TSM sont majoritaires. S'adressant à des personnes accusées de délits ou de crimes et souffrant de troubles psychiatriques, il propose un programme de soins individualisé comme alternative à la peine de prison. Si le programme est mené à son terme, les charges sont abandonnées. Les objectifs sont multiples : réduire la surpopulation carcérale, améliorer la qualité de vie et l'intégration des participants dans la communauté mais aussi, diminuer les taux de récidive. Si des études montrent l'efficacité des TSM, certains auteurs insistent sur leurs limites. Ils estiment qu'une part de leur efficacité serait, en réalité, liée à une sélection trop restrictive parmi les candidats potentiels. Plus globalement, les TSM sont critiqués car ils ont été conçus pour remédier aux carences d'un système de santé qui nécessiterait d'être réformé car il n'offre plus de soins en amont du système judiciaire. The purpose of the article is to present what are Mental Health Courts (MHC) that were developed in the wake of the movement of deinstitutionalization in the United States. Literature review. Designed in the 1990s, MHC are a form of diversion based on the principle of therapeutic jurisprudence: this individualized care program offer an alternative to prison. Today, there are more than 400 in the United States. Even though their functioning varies according to the States, they rely on common theoretical principles. Overall, many studies show a decrease of recidivism for participants of MHC compared to those who did not participate while they were eligible, whether in the short, medium or long term. Studies also present high levels of procedural justice and low levels of perceived coercion. If the studies show the efficiency of the TSM, some actors insist on their limits. They consider that a part of their efficiency would, in fact rely on a too restrictive selection amongst the potential candidates. More generally, the TSM are criticized because they have been conceived to overcome the deficiencies of a health system that would need to be reformed because it doesn't offer care upstream the judicial system. Several other aspects are discussed but also criticised, whether it is about the consent of the participants (what understanding of the programs and their juridicial foundation and, later on, which real part of volunteering in their commitment?) or about the dropping of charges, which are apparently not systematic in some States. MHC offer some promising leads but do not embody a solution to the complex problems found in the interface between mental care and justice. [ABSTRACT FROM AUTHOR]

La remédiation cognitive est une approche thérapeutique qui trouve ses fondements dans la notion de plasticité cérébrale. Elle a pour objectif d'améliorer certaines fonctions cognitives déficitaires par la répétition d'exercices spécifiques et de favoriser la dimension métacognitive. Chez l'enfant et l'adolescent, plusieurs programmes de stimulation cognitive ou d'entraînement cognitif existent, notamment pour le Trouble Déficit de l'Attention/Hyperactivité (TDAH). Les premiers résultats indiquent essentiellement des bénéfices en termes de mémoire de travail visuelle et verbale. En revanche, les effets de l'entraînement cognitif semblent avoir du mal à se généraliser sur d'autres apprentissages du quotidien et n'ont que des effets limités sur les symptômes. Le service de psychopathologie de l'enfant et de l'adolescent du Centre Hospitalier Sainte-Anne a utilisé le programme Neuropsychological Educational Approach to Cognitive Remediation (NEAR) pour des patients âgés de 11 à 15 ans présentant un TDAH ou un TSA. Cette méthode combine exercices cognitifs et groupe de thérapie comportementale et cognitive. Elle a comme intérêt de travailler simultanément certaines fonctions cognitives et la dimension métacognitive en encourageant la généralisation dans d'autres situations ou contextes de vie quotidienne. Les premières observations indiquent que ce programme montre une bonne acceptabilité auprès des adolescents et est adapté aux pathologies choisies. Les participants ont rapporté une amélioration sur le plan mnésique et à un degré moindre des bénéfices au plan attentionnel et en termes de planification. Les adolescents soulignent que la majorité des acquis a pu être transférable dans le milieu scolaire. Cette toute première application de ce programme chez des adolescents demande donc à être poursuivie et évaluée quantitativement à la fois par des données neuropsychologiques et au plan fonctionnel sur un plus grand échantillon. Cognitive Remediation is a therapeutic approach based on the notion of brain plasticity. It aims to improve certain cognitive function deficits through the repetition of specific exercises and to promote the metacognitive dimension (the awareness and reflection of an individual on his cognitions, his behaviors and the strategies he uses to solve a problem). Several programs have already been validated in adult patients with schizophrenia and have shown improvements in cognitive performance and functioning. Some of the programs were later applied to other pathologies such as anorexia nervosa or autism spectrum disorders (ASD). Remedial programs have also been developed for children and adolescents because the early symptomatic expression of certain disorders such as Attention Deficit Hyperactivity Disorder (ADHD) or ASD makes one suspect a neurodevelopmental origin and all have in common an alteration of the executive functions. There are programs of cognitive stimulation or cognitive training, particularly in the context of ADHD. Although the results do show benefits in terms of visual and verbal working memory, the effects of cognitive training seem to be difficult to generalize to other everyday learning and have only limited effects on the symptoms. The objective of this study is to assess the feasibility and acceptability of the Neuropsychological Educational Approach to Cognitive Remediation for Adolescents (NEAR). The Department of Child and adolescent Psychopathology of the Sainte-Anne Hospital (Paris), part of the reference center for remediation and psychosocial rehabilitation (C3RP), used NEAR, originally developed for adult schizophrenic patients, with four preadolescents and adolescents aged 11 to 15 years with either ADHD or ASD. The IQ ranged from 80 to 112 and none was under medication. This method combines cognitive exercises and Cognitive-Behavioral Therapy groups. The interest is in working simultaneously on cognitive functions such as memory, executive functions, attention, visuospatial abilities and the metacognitive dimension by building "bridges" between what has been worked on in the sessions and examples from daily life. One of the main focuses in the NEAR method is the principle of encouraging intrinsic motivation. The method also aims to restore confidence in the ability to acquire skills, to overcome certain failures regularly encountered by these adolescents in their schooling and to encourage the generalization and transfer of learning to other situations or contexts from daily life. The first observations show that this program is applicable and adapted to preadolescents and adolescents as well as to the pathologies targeted in this group. The participants reported improvement in memory. They also emphasized the benefits in attention and planning. Moreover, the adolescents report that the majority of learning has been transferable to the school environment. The commonest example was the use of techniques to improve their memory such as making a list, verbalizing (stating either aloud or mentally the subject matter of a course) or organizing information. Others have used attentional strategies learned during the group such as condensing information, pausing, using verbalization, or reducing sensory distractors. Another positive aspect of the group reported by all teenagers was the pleasure of seeing each other again every week, the perceived support and the development of self-help skills. Cognitive Remediation is now an additional therapeutic tool, which can empower other therapeutic approaches with no significant side effects. The development and evaluation of programs targeting a wider range of neuropsychological deficits than the NEAR program seems to us to be a future direction because children do not all have the same neuropsychological profile and they are often affected by several neuropsychological deficits. The first application of this program in adolescents is taking place within the Department of Child and Adolescent Psychiatry of the Sainte-Anne Hospital Centre. Neuropsychological and functional evaluations on a larger sample are underway. [ABSTRACT FROM AUTHOR]

Objective: To analyze the effects of chronic kidney disease (CKD) care programs on clinical outcomes.Design: An observational, retrospective study with medical record review.Setting: Kaohsiung Chang Gung Memorial Hospital.Participants: Patients diagnosed with CKD.Interventions: CKD care programs conducted by nephrologists-based team from 2006 to 2013 in our hospital.Main Outcome Measures: We set 10 goals with treatment target ranges based on the guidelines suggested by the following organizations: Kidney Disease Improving Global Outcomes (2012) and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (2003).Results: In total, 1486 patients were enrolled. Their average estimated glomerular filtration rate (ml/min/1.73 m2) was 31.9 at baseline and declined to 28.9 in Year 3 (P < 0.001). The all-goals attainment rate increased from 59.4% at baseline to 60.5% in Year 3, with an especially significant improvement for low-density lipoprotein (from 46.8% to 67.0%) and glycated hemoglobin (from 55.0% to 64.0%). Achievement rates decreased for hemoglobin (from 34.2% to 31.0%), calcium (from 94.6% to 92.3%) and phosphate (from 89.9% to 82.5%) between baseline and Year 3. Albuminuria was the least achieved goal (from 23.4% to 24.0%). Subgroup analysis revealed that estimated glomerular filtration rate did not decline in patients who had a good achievement rate, but decreased significantly in patients with a poor achievement rate.Conclusion: Enrolment in CKD care programs resulted in a significant improvement in goal attainment by patients. Further, a good achievement rate was associated with better preservation of residual renal function. [ABSTRACT FROM AUTHOR]

Objectives: Ventilator-associated pneumonia (VAP) is the most frequent hospital-acquired infections in intensive care units (ICU). In the bundle of care to prevent the VAP, the oral care is very important strategies, to decrease the oropharyngeal bacterial colonization and presence of causative bacteria of VAP. In view of the paucity of medical economics studies, our objective was to determine the cost of implementing this oral care program for preventing VAP.Materials and methods: In five ICUs, during period 1, caregivers used a foam stick for oral care and, during period 2, a stick and tooth brushing with aspiration. Budgetary effect of the new program from the hospital’s point of view was analyzed for both periods. The costs avoided were calculated from the incidence density of VAP (cases per 1000 days of intubation). The cost study included device cost, benefit lost, and ICU cost (medication, employer and employee contributions, blood sample analysis…).Results: A total of 2030 intubated patients admitted to the ICUs benefited from oral care. The cost of implementing the study protocol was estimated to be €11,500 per year. VAP rates decreased significantly between the two periods (p1 = 12.8% and p2 = 8.5%, p = 0.002). The VAP revenue was ranged from €28,000 to €45,000 and the average cost from €39,906 to €42,332. The total cost assessment calculated was thus around €1.9 million in favor of the new oral care program.Conclusion and clinical relevance: Our study showed that the implementation of a simple strategy improved the quality of patient care is economically viable.Trial registration: NCT02400294 [ABSTRACT FROM AUTHOR]

Résumé La loi du 5 juillet 2011 a introduit de nouveaux éléments dans la pratique des soins psychiatriques. Nous présenterons une étude observationnelle sur les soins sans consentement prodigués dans un échantillon de 510 cas inclus en Sarthe sur un an. Soixante jours après l’admission, la durée moyenne des soins était significativement plus courte pour les 115 cas en « péril imminent » (26,1 jours) versus les 342 cas « à la demande d’un tiers » (31,8 jours). Les hospitalisations initiées « sur décision du représentant de l’État » ( n = 53) avaient des caractéristiques différentes ( p ≤ 0,05) de celles « sur décision du directeur de l’établissement » ( n = 457). Les résultats de notre étude nécessitent d’être répliqués sur le plan national afin de mieux appréhender la pratique à travers le territoire. Introduction The French Mental Health Act was reformed by the law of July 5th 2011, adding new and useful tools in the therapeutic management of the mentally ill, such as the possibility of involuntary admission to a psychiatric ward in case of an “imminent danger” and involuntary psychiatric treatment in outpatient settings. In France, these measures concern over 100,000 hospital stays a year. We wished to test the hypothesis that there is no statistical distinction between groups of patients with different types of admission orders. Material and methods We designed an observational, retrospective, single-centre study. Inclusions in the sample concerned all adults (aged 18 or above) involuntarily admitted to the specialised psychiatric centre of the Sarthe county between November 1st 2013 and October 31st 2014. A single follow-up took place 60 days after the admission order had been pronounced and included data extracted from administrative and medical files. Results For the purpose of the study, each new admission was treated as a new “case”. Thus, 510 cases have been included in the main sample: 342 admitted upon a third persons’ application (67.1%), 115 for imminent danger (22.5%) and 53 upon the state's representative decision (10.4%). Follow-up data showed the average duration of involuntary treatment to be significantly higher between the first two groups, 31.8 vs. 26.1 days respectively ( p = 0.03). The state's representative group shared distinct clinical characteristics ( p ≤ 0.05) in terms of sex-ratio, initial application setting, length of involuntary treatment and hospital stay, as well as diagnosis, history of suicide attempt, rate of judicial hearings and care programming upon discharge from hospital. Discussion Our initial hypothesis was rejected. The type of measure was indeed significantly associated with different outcomes 60 days after admission. As was the case in other recent studies, the “imminent danger” group made up a significant part of the sample, highlighting its usefulness in emergency settings. This subgroup benefited from shorter hospital stays and had a significant tendency to see their admission order revoked at an earlier stage than in the case of a third party's application. This suggests that the incapacity to consent to treatment is less likely to last in the “imminent danger” group, although overall clinical characteristics are shared with the “third party” sub-sample. On the contrary, the combined “state's representative decision” group differed significantly from the rest of the sample on clinical grounds, especially a higher prevalence of psychotic disorders and a lower one for mood disorders. This could contribute to the higher rate of outpatient care programmes. Conclusion Our study points out some of the differences involving admission groups in psychiatric centers and is coherent with previous findings. However, given its single-centre approach and the notorious disparity of clinical practices over the national territory, it would be useful to include larger, nationwide samples, in order to assess the new Health Act's impact and to guide future public health decisions. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground:Both neuropsychiatric symptoms (NPS) and psychotropic drug use (PDU) are common in institutionalized People with Young Onset Dementia (PwYOD) and can produce negative outcomes such as reduced quality of life and high workload. In community-dwelling PwYOD, NPS are found to be associated with unmet care needs. This emphasizes the importance of a care program for the management of NPS in institutionalized PwYOD that also addresses unmet care needs and PDU. The objectives of the Behavior and Evolution of Young ONset Dementia part 2 (BEYOND-II) study are to develop a care program for the management of NPS in institutionalized PwYOD and to evaluate its effectiveness.Methods: The care program consists of an educational program combined with an intervention to manage NPS with the following five steps: the evaluation of psychotropic drug prescription, detection, analysis (including the detection of unmet needs), treatment and the evaluation of NPS. A stepped wedge design will be used to evaluate its effectiveness. The primary outcomes are agitation and aggression and other NPS. The secondary outcomes are PDU, quality of life, the workload of nursing staff and job satisfaction. Additionally, a process analysis and a cost-consequence analysis will be conducted.Conclusions: The study protocol of the Beyond-II study describes the development, implementation and evaluation of a care program for the management of NPS in institutionalized PwYOD. This care program provides a structured method for the management of NPS, in which unmet needs and PDU are also addressed. [ABSTRACT FROM AUTHOR]

Résumé Les programmes spécialisés pour les psychoses émergentes se sont largement développés dans le monde. La plupart de ces programmes incluent des éléments de suivi intensif dans le milieu ( assertive community treatment ). Il existe deux modèles. Dans le premier, le suivi intensif dans le milieu est proposé à tous les patients et constitue le cœur de l’intervention. Dans le second, un programme de case management standard est proposé à tous les patients et un case management intensif à un sous-groupe de patients difficiles à engager dans les soins. Le programme TIPP à Lausanne fait partie de cette deuxième catégorie. Le but de cet article est d’examiner dans un programme spécialisé pour les psychoses émergentes (TIPP) les caractéristiques et l’évolution de patients qui nécessitent ou non un suivi intensif dans le milieu, et de l’illustrer par des exemples cliniques. Il s’agit d’une étude prospective portant sur 229 patients inclus dans le programme TIPP de manière consécutive pendant trois ans. Environ un quart de ces patients ont nécessité un case management intensif. Au début du suivi TIPP, ces patients présentent une adhésion au traitement, un fonctionnement académique et un insight plus faibles, et ont des antécédents de consommation d’alcool et de cannabis. Après 18 mois, le niveau d’adhésion au traitement est semblable dans les deux groupes. Toutefois, les patients qui nécessitent un case management intensif continuent à présenter un niveau de fonctionnement plus faible, et davantage de symptômes psychotiques après trois ans de suivi. Many specialized early psychosis programs have been developed around the world. Most of these programs include elements of assertive community treatment. There are two models. In the first model, assertive community treatment is offered to all patients and is the core of the intervention. In the second model, a standard case management program is offered to all patients and an intensive case management to a subgroup of patients difficult to engage in care. TIPP, a specialized early psychosis program in Lausanne, is part of this second category. Objective The aim of this article is to examine the characteristics and outcomes of patients who require intensive case management versus standard case management, and to illustrate this with clinical examples. Methods This is a 3-year prospective study of 229 patients treated in TIPP. Results About one quarter of these patients required intensive case management. At the beginning of TIPP follow-up, these patients had lower adherence to treatment, academic functioning and insight, and had a history of alcohol and cannabis use. After 18 months, the adherence to treatment is similar in both groups. However, patients requiring intensive case management continue to have a lower functioning level and more psychotic symptoms after three years of follow-up. Conclusions A subgroup of patients needing more intensive care can be identified in a program for early psychoses. These patients adhere to treatment in the same way as those who require conventional case management, but do not evolve in the same way clinically. [ABSTRACT FROM AUTHOR]