[Family members integration in patients' care in haematology units: a new application of proximology.]. / L'intégration des familles aux soins des patients hospitalisés en hématologie : une nouvelle application de proximologie.

Hospitalization per se is a stress for the family members of a loved one. While their role as informal caregivers is well known with at home patients, especially in oncology, they usually are only mere visitors at the hospital. Hence the integration of family members of in patients' care might improve both patients and families' quality of life. Such a supportive care concept has been previously investigated in pediatric, neurology and intensive care units, but there is not such data in hematology although the therapeutic in this field is marked by long-term stay in hospitals' rooms. Since 2001, we developed in Clermont-Ferrand University hospital such a project of integration. Put together, the literature data and our first results (opinion poll) show that the main risk of this approach is the exhaustion of family caregivers, their fear of miss conduct and the alteration of the relationship they previously had with the patient. Conversely this approach is likely beneficial in improving both patients and family member's experience during hospitalization in lowering both patients' affective social and may be cultural loneliness and family members' feeling of uselessly and guilt. In France the development of supportive care and therapeutic education in oncology is nowadays encouraged and of there is no legal basis to restrain the development of this concept. Whose concept, nevertheless should be carefully set up and studied and its benefit remain to be clearly demonstrated.

[Assessment strategies of the impact of healing touch in nursing care]. / Strategie d'evaluation de l'impact du toucher dans les soins infirmiers.

New care methods have emerged in the last few years. Healing Touch is relaxing and as such, helps prepare the patient for the medical act, the pain of which he may often feel anxious about As they foster confidence between the patient and the medical practitioner, such practices create better conditions for the medical care act to be performed. Even if there is no doubt about its impact on the patient, the effect of Healing Touch has never been scientifically assessed, and the only available references are rather scarce. This is the reason why we wished to assess the impact of this care in a number of clinical situations through a randomised clinical experiment. The object of this paper is to assert the efficacy of such care on the patient, especially on pain relief and the decrease of anxiety. To this end, authenticated assessment scales were used, such as the visual analog pain scale or Spielberg's test anxiety inventory. A prospective multicentre randomised study was carried out to create a control group to be compared to the group treated with Healing Touch. Only willing patients who were prescribed healing touch were included in the experiment. Patients with cognitive problems - be they temporary (linked to a temporary clinical conditions) or not - or those suffering from some disabilities preventing them from using assessment scales and questionnaires are excluded. The recruitment of a 784-patient panel was needed to set out the 8 situations in which a Healing Touch indication may be effective.

[Knowledge and life experiences of mothers facing certain addictive behaviours in youths in the region of Tunis]. / Connaissances et vécu des mères de la région de Tunis vis-à-vis de certaines conduites addictives chez les jeunes.

We surveyed 415 mothers who regularly consult primary healthcare centres about their knowledge of addictive behavior in teenagers in relation to tobacco, alcohol and drugs. Most mothers considered the teenage period difficult. Apprehension of this period increased with the educational level of the mothers. Mothers did not often discuss the issue of addiction with their children, especially related to alcohol and drugs. Nevertheless, the mothers were aware of the risks of addiction. They considered information campaigns about this topic an efficient means of prevention. About half of the mothers had experience of addictive conduct involving a family member. They resolved the problems through family help or consultation with a specialist.

[Knowledge and life experience of mothers facing certain teenager's addictive behaviours in the region of Tunis]

We surveyed 415 mothers who regularly consult primary healthcare centres about their knowledge of addictive behavior in teenagers in relation to tobacco, alcohol and drugs. Most mothers considered the teenage period difficult. Apprehension of this period increased with the educational level of the mothers. Mothers did not often discuss the issue of addiction with their children, especially related to alcohol and drugs. Nevertheless, the mothers were aware of the risks of addiction. They considered information campaigns about this topic an efficient means of prevention. About half of the mothers had experience of addictive conduct involving a family member. They resolved the problems through family help or consultation with a specialist

Enquete connaissances - attitudes pratiques sur les accidents d'exposition au sang dans des structures de premiere ligne a Tunis

Les accidents d'exposition au sang (AES) constituent une menace reelle pour le personnel de sante . A notre connaissance; dans les deux circonscriptions sanitaires D'EL Ouardia et de Djebel jeloud ; peu d'actions en matiere de prevention des AES ont ete mises en ouvre. Nous y avons donc effectue une enquete connaissances ;attitudes ; pratiques (CAP) durant le mois d'avril 2007 dans le but d'evaluer la situation initiale; de mesurer le niveau global des connaissances et des pratiques du personnels expose et d'aider a la definition d'un programme de formation et d'amelioration .Un questionnaire a ete adresse a 49 personnes en utilisant la technique de l'intervieuw directe . Les resultats ont montre une bonne connaissance du risque de contamination par les trois virus VHB ; VHC et VIH . Le taux de vaccination contre l'hepatites B est de 59 . Le recapuchonna des aiguilles ; considere comme un geste a risque ; est une pratique retrouvee chez 58des repondants. la conduite a tenir en cas d'AES semble etre insffisamment connue par notre echantillons. Ces resultats nous ont permis de mettre en place une demarche qui permet de renforcer la sensibilisation et d'ameliorer la prise de conscience des professionnels de sante vis-avis des risqu d'AES..Le recapuchonnage des aiguilles; considere comme un geste a risque; est une pratique retrouvee chez 58des repondants. La conduite a tenir en cas d'AES semble etre insuffisament connue par notre echantillon. Ces resultats nous ont permis de mettre en place une demarche qui permet de renforcer la sensibilisation et d'ameliorer la pise de conscience des professionnels de sante vis-a-vis des risques d'AES

Cell population dynamics modulate the rates of tissue growth processes.

The development and testing of a discrete model describing the dynamic process of tissue growth in three-dimensional scaffolds is presented. The model considers populations of cells that execute persistent random walks on the computational grid, collide, and proliferate until they reach confluence. To isolate the effect of population dynamics on tissue growth, the model assumes that nutrient and growth factor concentrations remain constant in space and time. Simulations start either by distributing the seed cells uniformly and randomly throughout the scaffold, or from an initial condition designed to simulate the migration and cell proliferation phase of wound healing. Simulations with uniform seeding show that cell migration enhances tissue growth by counterbalancing the adverse effects of contact inhibition. This beneficial effect, however, diminishes and disappears completely for large migration speeds. By contrast, simulations with the "wound" seeding mode show a continual enhancement of tissue regeneration rates with increasing cell migration speeds. We conclude that cell locomotory parameters and the spatial distribution of seed cells can have profound effects on the dynamics of the process and, consequently, on the pattern and rates of tissue growth. These results can guide the design of experiments for testing the effectiveness of biomimetic modifications for stimulating tissue growth.

[Development of a self-administered questionnaire to assess women's satisfaction with maternity care]. / Développement d'un auto-questionnaire évaluant la satisfaction des femmes à l'égard des maternités.

OBJECTIVES: We describe the development and the validation of a French self-administered questionnaire which measures women satisfaction concerning care given during pregnancy. The analysis includes pregnancy monitoring, hospitalization for delivery and homecoming. METHODS: We considered the content validity, internal-consistency and the reproducibility by test-retest estimates. This survey also compared the characteristics of respondents and non-respondents. RESULTS: Response rate was 61% and the rate of reply per question was greater than 90%. Eleven dimensions are identified by principal-components analysis. Ten of them had good Cronbach's alpha coefficients (0.58 to 0.83). The convergence between open comments and questions and between the different methods to measure satisfaction was good. The test-retest estimates for each dimension were correct. CONCLUSION: This questionnaire is reliable. It is a valid tool for evaluation of satisfaction after pregnancy. Designed to be sent to the woman's residence 2 months after childbirth, it can be easily used in common practice.

[The use of exit questionnaires, a survey at 7 hospital centers]. / L'utilisation des questionnaires de sortie, une enquête auprès de 7 centres hospitaliers.

Measuring the satisfaction of hospitalised patients has been mandatory in France since 1996. The most common tool for assessing the level of satisfaction is the use of self-administered questionnaires given to the patient upon his/her release from the hospital. A survey was conducted among seven public hospitals to appraise the development and use of such questionnaires, their results and the way in which these results are taken into account in order to improve the quality of care. The survey's results illustrate that the policy with respect to their construction varies between hospitals, without any evaluation of the validity of the questionnaires produced. In most cases, the questionnaires are passively distributed to the patient at the time of discharge. The response rates are low (ranging from 4 to 18%), and the analysis of the collected questionnaires, to the extent to which it is done, is not necessarily used to improve the quality of care. An appropriate evaluation strategy, one capable of effecting change and improving hospital care, still remains to be established in the hospitals which participated in the survey.

[Reserved reception of the general health report of France: an evaluation of the national federal of regional health observatories]. / L'accueil réservé au rapport général sur la santé en France: une evaluation de la fédération nationale des ORS.

At the request of the High Committee for Public Health (HCSP), an evaluation of the reception of its report, "Health in France" was carried out by the National Federation of Regional Health Observatories. Forty semi-directive interviews among actors of the health system from various geographic and professional backgrounds were carried out. It appears that the HCSP is an authority that is not well-known, for the most part. The report itself was mainly distributed by administrative networks; in the majority of cases, only the first part is well-known and was the particular focus of the interviewees. Overall, this document is a work instrument, a global tool, and a reference document. Several improvements are proposed concerning its form, the list of subjects covered, as well as the means of distribution.

[Comparative evaluation of maternity hospitals in Auvergne: from planning to contracting]. / Evaluation comparative des maternités en Auvergne: de la planification à la contractualisation.

Two reforms of public hospitals have been launched by the French government in 1991 and 1996 aimed at lowering costs and increasing the quality of services and ultimately the safety of patients. As concerns maternity hospitals, several new rules have been imposed upon. For example, those who performed less than 300 births a year should be closed. The basic idea was to concentrate technical resources and human skills in middle-size and important hospitals for saving money, and simultaneously, raising the safety level for mothers and babies. However, negative adverse effects fastly appeared: to avoid closure, some small maternity homes tried to convince future mothers not to go to well-equipped hospitals, even if their cases appeared complex and their health at risk. An experience of partnership between maternity hospitals (care providers), the Sickness Insurance Fund (the financing body) and the Administration was carried out in the Auvergne region. It was based on the observation of a large number of indicators concerning the activity of hospitals, the size and quality of their equipment, the satisfaction of their patients ... etc ... for designing the rights and duties of each partner. Instead of planning from the summit, a process of mutually-agreed contract was established.