["Thanks to all this good care, we progressed quickly"]

Sohane and Sélenn are twins and will soon be 6 years old. They had a birth journey often described as unusual, because they were born far too early, at 31 weeks of amenorrhea. Through the pen of their father, they share their testimony with us, looking back on this complicated period of which they were able to keep memories thanks to the photographs and stories of their parents.

[Towards an ideal environment in neonatology]

The establishment of sensory systems occurs gradually along a transnatal continuum. During premature birth, hospitalization in neonatology, through its atypical sensory stimulations, can disrupt the development of the baby's still immature brain. To promote harmonious development in children, caregivers and parents must learn to take into account their sensory expectations in order to create the most suitable environment possible for their development.

[Accompanying teams to decipher and manage emotions in certain care situations]

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

[Psychiatric care in specially equipped hospital units]

The specially equipped hospital units (UHSA) receive detainees in the region (men, women, minors) requiring full psychiatric hospitalization, either in free care or in care by decision of the State representative. They are located on the site of hospitals, but a penitentiary enclosure allows for the control of the entry and exit of patients, as well as the security of the perimeter. To date, nine UHSAs are in operation in France.

[Health needs and organization of care in prison]

The prison population in France is mostly composed of young but aging men, in relatively good health but vulnerable. In order to ensure optimal health care for this population, several levels of health care organization - somatic and psychiatric - have been set up since 1994. The different structures created since then allow incarcerated patients to benefit from care adapted to their particular conditions.

[Psychiatric intensive care units]

The intensive psychiatric care units are intermediate health structures between the sector psychiatric services and the units for difficult patients. Prisoners can be treated there under article D. 398 of the Code of Criminal Procedure.

[Development of the concept of positive spirituality in health]

Positive spirituality has three central attributes: connectedness, meaning of life, and identity. Six factors are likely to contribute to its emergence and it can allow the development of ten positive consequences.

Long-Term Care Facility Workers' Perceptions of the Impact of Subcontracting on their Conditions of Work and the Quality of Care: A Qualitative Study in British Columbia

Subcontracting long-term care (LTC), whereby facilities contracted with third party agencies to provide care to residents, became widespread in British Columbia after 2002. This qualitative study aimed to understand the impact of subcontracting from the perspective of care workers. We interviewed 11 care workers employed in subcontracted facilities to explore their perceptions of caring and working under these conditions. Our overarching finding was one of loss. Care workers lost wages, benefits, security, and voice. Their working conditions worsened, with workload and turnover increasing, resulting in a loss of experienced staff and a loss of time to provide care. These findings call into question the promises of quality and flexibility that legitimated policies permitting subcontracting, while adding to the mounting evidence that subcontracting LTC harms both workers and residents.

[Lesbians - gays - bisexuals - transgender (LGBT) and healthcare]

For a long time reduced to sexual and reproductive health issues (human immunodeficiency virus and medically assisted procreation in particular), lesbian, gay, bisexual and transgender (LGBT) health has recently shifted to other topics that make it possible to report on the relationship between LGBT people and health care. A recent study attempts to qualify and quantify the fears, avoidances, strategies and representations that LGBT people have of the care, health care bodies and caregivers they encounter. It is possible to summarise some of the trends in this research and to propose avenues and topics to better support LGBT people in their care journey.

[Compassion fatigue and empathetic suffering]

Compassion fatigue and empathetic suffering are terms generally applied to health care providers caring for elderly people. An exhaustion accompanied by acute emotional pain results of tension and preoccupation with the suffering of those being helped. Learning to recognize it and to manage its symptoms is the first step toward healing. Compassion is an important care index and a professionalism marker.

[Continuity in care or how to build oneself in the pleasure of the bond]

Caring for children necessarily raises questions about the importance of continuity. Continuity in care allows the child to integrate a base of security and thus to live a psychological continuity, which will allow him to face the outside world. Acquiring a sense of self-confidence is a construct, fostered by the commitment and reflection of professionals.

[Infections associated with care at the urology department of the Gabriel Touré University Hospital]

OBJECTIVE

To study infections associated with care in the urology department of the Gabriel Touré University Hospital.

PATIENTS AND METHODS

This was a prospective, descriptive study from April 1 to September 31, 2016 in the Urology Department of CHU Gabriel TOURE. Included in this study were all inpatients (operated and non-operated) in the department. Not included are non-consenting patients and patients admitted for necrosectomy. The following parameters were studied: age, sex, origin, nationality, ASA score, BMI, WHO performance index, duration and type of intervention, ECBU, ECB,GE, antibiotics, antiseptics used, mortality, morbidity.

RESULTS

We collected 203 patients, 30 (15%) of whom had healthcare-associated infections. The mean age of patients with a healthcare-associated infection was 58 years with a standard deviation of 24.5983 and a sex ratio of 5,2. ASA patients had a healthcare-associated infection in 70% of cases and ASA2 in 52% and ASA3 in 100% of cases. We recorded 13 patients infected with NNISS score=0 or 9%, 12 cases infected with NNISS score=1 or 24% and 3 cases infected with NNISS score=2 or 27%. Fever appeared in 35% of patients from the 4th day; fever was recorded from the 5th, 6th, 7th and 11th days, i.e. 5 to 30%. Organ suppurations dominated with 52%, followed by superficial suppurations of 38%, and 10% deep suppurations. The majority of patients had a suppuration between the 4th and 6th day of the operation, i.e. 65%. Germs are in order of frequency: E. coli (40.74%); Klebsiella pneumoniae (37.03%); Enterococcus faecalis (14.81%); Pseudomonas aeroginosa, (3.70%) and Acinetobacter baumannii (3.70%). Nitrofurantoin has been effective on E. coli, K. pneumoniae, and E. faecalis.

CONCLUSION

Care-associated infections are potentially serious and sometimes fatal, prolonging the duration of hospitalization with a definite impact on patients' post-operative rehabilitation.

[Agitation and aggression in elderly persons with dementia]

Managing aggression and agitation in elderly people with dementia can be seen from the perspective of certain conditions. Some therapies, particularly the use of neuroleptics, should be avoided. The need to put limits on non-pharmacological treatments must be emphasised.

[Reflection on the use of humour in care]

The hospital is a healthcare setting in which staff often manage acute health situations. Patients, families and healthcare professionals constantly interact, often against a background of emergencies and anxiety. In such contexts, communication plays an important role in establishing a compassionate relationship. Does humour have a place in this relationship? If so, in what form and what are the benefits for the teams and the patients?

[Eating disorders as a response to a traumatic assault]

A sexual trauma can lead to the development of an eating disorder; it is a relationship with the body as an object and a search for empowerment in the relationship with others. Nevertheless, the treatment of the trauma and the associated disorder, as well as the support of the immediate circle are possible forms of converging care for restoring health, for restoring the body and words.

We Are Caregivers: Social Identity Is Associated with Lower Perceived Stress among Rural Informal Caregivers

ABSTRACTInformal caregivers often experience high stress levels with little support, especially in rural settings. With a mixed-methods approach, this research explored experiences of rural informal caregivers, including how social identification as a caregiver, social interactions, and formal and informal coping support related to perceived stress. Major focus group themes (n = 8) included lacking available services, balancing challenges, unmet practical needs, and strong community identity. Survey data (n = 22) revealed that perceived coping support (e.g., having someone to turn to), social interactions, and caregiver identity (e.g., perceiving the role as important to one's self-concept) were associated with lower life upset stress, but only caregiver identity was associated with managing the personal distress and negative feelings associated with caregiving stress. Results suggest that, although available rural services may fall short, other options might alleviate caregiver stress, including facilitating access to coping support, encouraging social interactions, and enhancing caregiver social identity.

[Overview of the health care of elderly prisoners]

The prison population is ageing. Caregivers are having to work in an environment which is unsuited to the care of elderly prisoners. The French law of 18 January 1994 relating to public health and social protection, radically changed the health care provision for people in prisons. The methodological guide relating to their care constitutes a valuable aid to its application. Since then, various laws have been modified by the Code of Criminal Procedure, improving the way the health status of prisoners in general and elderly prisoners in particular is taken into account.

[Justice and access to care]

Evoking justice in the field of care can be paradoxical considering the natural inequalities inherent to health. This article reflects on whether the use of the term justice in relation to access to care refers to equality or equity.

[Gaps in Hepatitis C Care of People Who Use Drugs]

Zusammenfassung. Drogenkonsumierende sind mit einer Prävalenz von 56 % die grösste Hepatitis-C-Risikogruppe in der Schweiz. Ihre ungenügende Versorgungssituation stellt ein ernsthaftes Problem für die öffentliche Gesundheit dar, einerseits durch die Weiterverbreitung des Virus und anderseits durch die Folgeerkrankungen der Infektion mit den entsprechenden Kosten. Es sind neue Ansätze gefragt in der Hepatitis-C-Versorgung bei Drogenkonsumierenden. Eine Suchterkrankung und auch Hepatitis C sind chronische Leiden, die häufig von weiteren chronischen Krankheiten begleitet werden. Sie bedürfen einer integrierten multidisziplinären Versorgung. Mit einer Einbindung der Hepatitis-C-Versorgung in das medizinische Grundversorgungssetting können bislang unerreichte Patientengruppen behandelt werden. Die aktuelle Entwicklung in der HCV-Therapie, weg von anspruchsvollen interferonbasierten Behandlungsschemata und hin zu einfachen Kombinationstherapien, unterstützt die Versorgung dieser Risikogruppe.

[Alcohol intoxication in old age]

Acute alcohol intoxication occurs in elderly subjects. Drunkenness appears in banal clinical forms in geriatrics: falls, dizziness or confusion. Elderly people are more vulnerable to alcohol and need less alcohol to become intoxicated. Age does not exclude the possibility of receiving alcohol addiction treatment. Broaching the subject with an elderly person, the day after a drunken episode, is useful and recommended.

[The nurse on a remote mineral, gas or oil extraction site]

On mineral, gas or oil extraction sites, medical care is often provided in uncommon conditions by doctors or paramedical staff. Caregivers must fulfil certain requirements, but must also possess the necessary human, technical, physical and psychological qualities to be able to provide high quality care throughout their mission on a remote site.

[Not Available]

Zusammenfassung. In der Schweiz sterben jährlich mehr Personen an den Folgen von Hepatitis C als an jenen von HIV. Schätzungsweise 83 000 Menschen sind mit dem Hepatitis-C-Virus infiziert. Mehr als die Hälfte von ihnen ist nicht getestet und hat somit keine Chance, von den neuen, hochwirksamen Hepatitis-C-Medikamenten zu profitieren. Mit einer Heilung dieser systemischen Infektionskrankheit, die mit den neuen Medikamenten in über 90 % der Fälle erreicht werden kann, kann sowohl die leberbedingte als auch die extrahepatische Morbidität und Mortalität stark gesenkt werden. Mit der Vision der Elimination von Hepatitis C bis 2030 plant und implementiert die Schweizerische Hepatitis-Strategie Massnahmen auf allen Ebenen zur Bekämpfung dieser folgenschweren Epidemie.

Benefits of an outreach education coordinator: a burn center's experience

Education of first responders and referring medical professionals is considered vital to high-quality burn care. Prior to 1999, the community education program at The Burn Center of MedStar Washington Hospital Center (MWHC) was staffed by ICU nurses who volunteered their time. As the program became more popular in the mid-1990s, the requests for lectures exceeded the capacity of a volunteer program. A request to hospital administration for a full-time education coordinator position was rejected in the climate of budget cut-backs and declining reimbursement. A business-oriented proposal, ultimately accepted, promised an increase in admissions, an improved payor mix, and an annual review of data to demonstrate the cost/benefit advantage. To advertise the creation of the coordinator position and education programs, letters were mailed to local fire departments, nursing schools and emergency departments. The response was positive, and, with a full-time coordinator, the requests were accommodated in a timely manner. Community education programs increased almost four-fold. Average annual admissions increased initially from 292 to 374 and have continued to increase, rising to 812 in fiscal year 2008. As expected, the average percent total body surface area burns decreased (from 10.8% to 6.9%), reflecting increased referral of smaller burns and, inferentially and per analysis, an improved payor mix. Most impressive was the increase in charitable donations, from an annual average of $27,500 before the position was created to an average of $183,000 annually thereafter. From this experience as well as the experience discovered by a national survey, there are desirable side effects of a full-time community burn education program coordinator, and the cost for The Burn Center at MWHC has been more than balanced by the benefits.

Cost-optimization in the treatment of multidrug resistant tuberculosis in Nigeria

OBJECTIVE

To compare the cost of facility-based MDR TB care (F) to home-based care (H) from the perspective of the Nigerian national health system.

METHODS

We assessed the expected costs of the two MDR TB treatment approaches using a decision-analytic model with a follow-up of 6 months. MDR TB treatment outcomes were obtained from a systematic review of randomised clinical trials. The outcomes of interest included treatment success, treatment failure, treatment default and mortality and did not vary significantly between the two alternatives. Treatment costs included the cost of the following: drug therapy (F, H), hospital stay (F), nurse care (F, H), physician care (F), nursing facility (F) and transport to the healthcare provider (H). Finally, we estimated the potential cost savings associated with home-based treatment for all patients starting MDR TB treatment in Nigeria.

RESULTS

The average expected total treatment cost for a Nigerian patient treated for MDR TB was estimated at US2095 for facility - based care and 1535 for home-based care, a potential saving of 25%. One of the major drivers of this difference is significantly more intensive, and therefore more costly, nursing care in hospitals. In 2013, a total of 426 patients were initiated on facility-based MDR TB treatment in Nigeria. Thus, the potential savings through home-based care are US$ 223 204 per year.

CONCLUSION

In Nigeria, treatment of MDR TB using home-based care is expected to result in similar patient outcomes at markedly reduced public health costs as facility-based care.

[The ethical reflection approach in decision-making processes in health institutes]

Except in the specific case of end-of-life care, the law says nothing about the way in which health professionals must carry out ethical reflection regarding the treatment of their patients. A problem-solving methodology called the "ethical reflection approach" performed over several stages can be used. The decision-making process involves the whole team and draws on the ability of each caregiver to put forward a reasoned argument, in the interest of the patient.

Intra-couple Caregiving of Older Adults Living Apart Together: Commitment and Independence

Recently, rising numbers of mid-life and older adults are starting a "living apart together" (LAT) relationship following divorce or widowhood. LAT describes an intimate relationship wherein partners maintain separate households. This study investigated the characteristics of care arrangements in older long-term LAT couples and elicited personal comments about intra-couple care. We interviewed 25 LAT partners and a comparison group of 17 remarried older adults in the Netherlands in a side study of the Netherlands Kinship Panel Study. Results showed that about half of the LAT partners intended to exchange care if needed (partnership commitment); the other half had ambiguous feelings or intentions to refuse care (independence orientation). However, for those LAT partners already confronted with illness in their current relationship, all provided care to the partner in need. The minority of LAT partners who would not exchange care reciprocally are more likely to give as opposed to receive care.

[Characteristics of nursing home residents in the Marne department]

A study was carried out in the Marne department with the aim of describing the comorbidities and the treatments of a representative sample of the population living in nursing homes. It reveals the most frequent pathologies and the most commonly prescribed classes of therapies thereby aiding the assessment of the care costs of elderly people and the anticipation of their needs.

[Nursing research and the Hospital Programme for Nursing and Allied Health Research]

Nursing research is perceived as a way of improving quality of care. As is the case in Britain and Switzerland, this ambitious activity is developing in France, favoured by the raising of nursing studies to university level and boosted by funding from the French ministry of health. A nursing team at Pitié-Salpêtrière hospital, in Paris, share their enthusiasm for this new approach.

[The nurse-healthcare assistant partnership in a mobile pain and palliative care team]

The mission of the mobile pain and palliative care team is to improve the quality of care and comfort of patients. At Longjumeau general hospital the nurse-healthcare assistant partnership within this team enables the patient to benefit from the caregivers' two-way perspective, while allowing the professionals to share knowledge and to be stronger in the face of suffering.

Sexual violence in post-conflict Liberia: survivors and their care

Using routine data from three clinics offering care to survivors of sexual violence (SV) in Monrovia, Liberia, we describe the characteristics of SV survivors and the pattern of SV and discuss how the current approach could be better adapted to meet survivors' needs. There were 1500 survivors seeking SV care between January 2008 and December 2009. Most survivors were women (98%) and median age was 13 years (Interquartile range: 9-17 years). Sexual aggression occurred during day-to-day activities in 822 (55%) cases and in the survivor's home in 552 (37%) cases. The perpetrator was a known civilian in 1037 (69%) SV events. Only 619 (41%) survivors sought care within 72 h. The current approach could be improved by: effectively addressing the psychosocial needs of child survivors, reaching male survivors, targeting the perpetrators in awareness and advocacy campaigns and reducing delays in seeking care.

[Pain and conflicts: a comparative approach and implications for end-of-life quality of care]

Are conflicts to an organization what pain is to an organism?

OBJECTIVES

To explore the similarities and the differences between pain and conflicts in palliative care settings, and to better understand the potential importance of conflicts in end of life quality of care.

METHODS

Comparative and reflective methods focusing on how conflicts and pain are taken care of in health structures.

RESULTS

Pain and conflicts present numerous similarities such as identity, typology, prevalence, warning function, economic and social costs, denial, occultation and hurdles to appropriate management. Differences also exist regarding pain - there are prevention programs on local and international levels; there are specific research and training programs; and there is also some social visibility. This does not yet exist on a larger scale regarding conflicts.

CONCLUSION

Decision makers at clinical and public health levels should probably push to label conflicts as indicators of quality of care and develop appropriate health policy programs.