La Recherche Infirmière en France / La Investigación Enfermera en Francia / Nursing Research in France

Este artículo tiene como objetivo presentar una visión general de la investigación en enfermería en Francia. Para ello, se estructurará de acuerdo con tres temas principales: actividad de investigación a partir de 3 estudios originales, promoción de la investigación, luego gestión y transferencia de conocimiento. En Francia, los desafíos de la investigación en ciencias de enfermería son ricos y variados, pero deberían dar lugar a varios puntos de reflexión. Si bien hay cada vez más enfermeras investigadoras francesas, los temas de investigación aún están influenciados principalmente por la financiación de la investigación. También se eligen en función de los intereses personales del investigador. Finalmente, la brecha entre la teoría y la práctica existe como en todos los países y la reinversión de la investigación en la práctica parece ser un problema general. Parece que la universalización y, en particular, la creación de posiciones de doble membresía indudablemente deberían ayudar a reducir esta brecha entre la teoría y la práctica.(AU)

This article aims to present an overview of nursing research in France. To this end, it will be structured according to three main themes: research activity based on 3 original studies, the promotion of research, and knowledge management and transfer. In France, the challenges of nursing research are rich and varied but must give rise to several points of reflection. While there are more and more French nurse researchers, research themes are still mainly influenced by research funding. In addition, they are also chosen according to the researcher's personal interests. Finally, the gap between theory and practice exists as in all countries and the reinvestment of research into practice seems to be a general problem. It seems that universitarisation and in particular the creation of dual membership positions should undoubtedly help to reduce this gap between theory and practice.(AU)

Cet article se propose de présenter un état des lieux la recherche infirmière en France. Pour cela, il sera structuré selon trois grandes thématiques: l’activité de recherches à partir de 3 études originales, la promotion de la recherche, puis la gestion et le transfert de connaissances. En France, les enjeux de la recherche en Science infirmière sont riches et variés mais doivent susciter plusieurs points de réflexion. Alors qu’il y a de plus en plus d'infirmières française chercheuses, les thèmes de recherche sont encore principalement influencés par le financement des recherches. Par ailleurs, ils sont aussi choisis en fonction des intérêts personnels du chercheur. Pour finir, le fossé entre théorie et pratique existe comme dans tous les pays et le réinvestissement de la recherche dans la pratique semble être un problème général. Il semble que l’universitarisation et notamment la création de corps bi-appartenants devrait sans doute contribuer à réduire ce fossé entre théorie et pratique.(AU)

Support practices by an interdisciplinary team in a palliative-care unit for relatives of patients in agonal phase.

BACKGROUND: In the absence of extant recommendations, the aim of this study was to formalise support practices used by an interdisciplinary team in a palliative-care unit (PCU) for the relatives of patients in the agonal phase preceding death. The secondary objective was to understand the expectations of relatives during this phase in terms of the support provided by professionals and volunteers. METHODS: Thirty-two people took part in this study; all were interviewed through focus groups (FGs). Each FG comprised one category of individuals working in the PCU: nurses, care- assistants, doctors, psychologists, other professionals, palliative-care volunteers, and relatives. Groups were surveyed using an interview guide, and the interviews were recorded and transcribed to enable identification and characterization of all practices. Care practices were classified into four categories: current consensual practices (i.e. performed by all team members), occasional consensual practices, non-consensual practices (performed by one or a few participants), and practices to be developed. RESULTS: In total, 215 practices were mentioned by professionals and palliative-care volunteers: 150 current consensual practices, 48 occasional consensual practices, 1 non-consensual practice, 16 practices yet to be developed, and 29 practices for relatives. Many practices were mentioned by different categories of participants; thus, after cross-checking, the number of practices decreased from 215 to 52. A list of practices deemed desirable by all was drawn up and then validated by the entire interprofessional team. These practices were organised around four themes: providing care and ensuring comfort; communicating, informing, and explaining; interacting; and mobilising interdisciplinary skills. CONCLUSIONS: These results underline the importance of the quality of care provided to patients, the attention given to the relatives themselves, and they highlight the importance of the helping relationship. Following this study, which established a list of varied practices aimed at supporting the relatives of patients in agonal phase, it will be important to set up a broader study seeking to establish a consensus on these practices with an interprofessional group of experts from other PCUs using broad surveys and an adapted methodology. Such studies will make it possible to develop training modules for teams working with relatives.

[Research ethics: French regulations and applications in radiation oncology]. / Éthique de la recherche : réglementations françaises et applications en oncologie radiothérapie.

French regulations about research ethics are based on the so-called Jardé law, which defines researches involving human beings. Researches involving human beings require the submission of research protocols to a committee for protection of persons with a precise list of documents to submit for a favourable opinion. This law describes different categories of researches and determines the ethical procedures to apply before setting up a research protocol. This issue of categorisation is central and must be taken into account by researchers from the beginning of the research process. Researches considered as not involving human beings also require a set of ethical precautions focused on patients' information and the collection of their non-opposition (due to the application of the General Data Protection Regulation adopted by the European Parliament). Thus, many regulations exist and they require a real work for researchers to meet these requirements in research ethics. This article aims to summarise French regulations. Selected examples are specifically taken into the field of radiation oncology research.

The role of the randomised controlled trial in restorative dentistry and the correct purpose of observational data.

It has been argued that the randomised controlled trial design is unsuitable for restorative dentistry and that cohort studies or the analysis of large observational datasets without randomisation is more suitable. This opinion article examines why randomisation in clinical trials is needed and why big observational data is not enough for clinical inference.

[Consensus approach: Prior to the construction of an evaluation scale of risk constipation patients hospitalized for nursing practice]. / Approche par recherche de consensus : un préalable à la construction d'une échelle d'évaluation du risque de constipation des patients hospitalisés destinée à la pratique infirmière.

BACKGROUND: Constipation is a frequent issue during hospitalization. Multiple causes such as the existence of irregular habits, lack of exercise as well as medical history have been identified. Drugs such as strong painkillers, central nervous system therapies and treatments of the digestive tract are a major cause of constipation. Additionally, unbalanced diet, fluid deficiency, and anxiety may aggravate constipation. The consideration of all these risk factors being under the responsibility of nurses. The difficulty to take into account such a multifactorial aetiology in nursing practice and the fact that there is no easy to use and validated tool to assess the risk of constipation in current nurse practice has led us to consider the development of a Risk Assessment scale of Constipation in Patient Hospitalized (ERCoPH) to facilitate preventive management of this trouble. We present here the first step of the elaboration of this scale, the identification of risk factors through a consensus approach after a systematic literature review. METHODS: The key informants consensus-based approach proposed by Pineault and Daveluy is based on five steps: (1) a literature review to identify risk factors for constipation; (2) the elaboration of a questionnaire containing the factors identified in the first step; (3) pre-select a panel of experts; (4) submission the questionnaire to the panel; (5) analysis the results of the consensus survey. Only factors that received a rating>6 by at least 80 % of the experts were retained. RESULTS: The systematic literature review identified 69 risk factors submitted to the 23 experts of the panel. Fifteen risk factors were retained after analyzing the answers of the experts. The Scientific Committee added eight risk factors because of their importance in the literature and decided to group together some factors of the same domain. CONCLUSION: A total of 19 risk factors were selected and grouped by major class (age, physical activity, medication, social data, food/hydration, medical and surgical history and environmental data). These factors have been tested among 300 patients enrolled in different clinical settings as part of the construction and validation of ERCoPH.

CONTENT OF 70 kDa STRESS PROTEIN DURING ACCLIMATION OF MUSSEL MYTILUS EDULIS L. TO LOW SALINITY.

The paper deals with the dynamics of stress-proteins content in gill epithelium of bivalved mollusks Mytilus edulis in the course of their phenotypic adaptation to the changes of environmental salinity. It has been shown that in low salinity (10 ‰) causing the work of «isolating reflex¼, the induction of stress proteins from HSP70 family comes on the 5th day of the acclimation. Parallel measurements of the mussels extravisceral liquid osmolarity have shown that the signal for stress-protein induction in these mollusks is the osmolarity of their inner medium, but not the salinity of marine water outside.

Presentation of the vascular supply of the proximal ulna using a sequential plastination technique.

PURPOSE: The purpose of this study was to demonstrate the peri- and intraosseous vascular supply of the proximal ulna. METHODS: Eleven fresh human cadaveric elbows were sequentially plastinated beginning with arterial injection, followed by block and secondary slice plastination of the whole elbow. With this technique, we obtained completely transparent cadaveric slices in which the peri- and intraosseous vascular architecture could be studied. RESULTS: Proximal ulna vascularization is due to an arterial network: a superior and inferior collateral ulnar artery and the profunda brachial artery climbing to the olecranon from proximal. An anterior artery and a posterior recurrent artery climb up distally to the medial parts of the ulna and an interosseous recurrent artery is responsible for the lateral and posterolateral proximal part of the ulna. The intraosseous vascularization is due to directly penetrating branches out of the posterior recurrent ulnar artery and a vascular plexus at the olecranon tip. In addition, we saw a major distal bone penetration branch coming from the recurrent posterior artery, climbing intraosseously without junction to the proximal penetrating branches. CONCLUSION: The peri- and intraosseous vascularization of the proximal ulna was shown. A transitional zone of the intraosseous vascularization of the proximal ulna was detected.

Failure to look beyond blocks is a mistake.

Tamm and Hilgers are to be congratulated for bringing more attention to a rather important issue in trial design, namely chronological bias. Far too many researchers use permuted blocks without even recognizing that chronological bias is the reason they do it. Only armed with the rationale can we hope to enter an informed discussion regarding the merits, or lack thereof, for using permuted block randomization in actual trials. But chronological bias is only part of the story. If it were the entire story, then there would be a rather easy solution. We could just use blocks of size two, or even alternate treatment groups. But we can't, and the reason we can't is selection bias. The two are at odds, as the solution to chronological bias is a small block size, and the solution to selection bias is a large block size. At least this would be the case if we were limited to using permuted blocks. Fortunately, we are not.

Exploring the religious and spiritual coping experience of cases via cancer: A qualitative research.

Objective: Lately, the spiritual and religious (S/R) aspect of health behave has been receiving an increased attention in the scientific literature. The study aims to show the components of R/ S coping in cases of cancer in Iran. Method: The design of the current research is according to a qualitative research using content analysis. Sixteen patients with various kinds of cancer take part in the research. Data was produced though in-depth discussions and the gratified investigation utilized to discover categories and sub-themes. Results: Three categories combined from the information investigation: 1) Maintaining/ improving self-esteem, 2) Positive appraisal/ Being optimistic, and 3) Self-sustaining. In the participants' view, the general category realized to be the "improving calmness". Conclusions: Positive R/S coping strategies were used by the patients and most cancer patients tried to achieve calmness through R/ S coping. The findings of the research can be used to plan medical and nursing approach towards increasing the R/S quality care both in the acute and the long-term settings.

On the dose calculation at the cellular level and its implications for the RBE of (99m)Tc and ¹²³I.

PURPOSE: Based on the authors' previous findings concerning the radiotoxicity of(99m)Tc, the authors compared the cellular survival under the influence of this nuclide with that following exposure to the Auger electron emitter (123)I. To evaluate the relative biological effectiveness (RBE) of both radionuclides, knowledge of the absorbed dose is essential. Thus, the authors present the dose calculations and discuss the results based on different models of the radionuclide distribution. Both different target volumes and the influence of the uptake kinetics were considered. METHODS: Rat thyroid PC Cl3 cells in culture were incubated with either(99m)Tc or (123)I or were irradiated using 200 kV x-rays in the presence or absence of perchlorate. The clonogenic cell survival was measured via colony formation. In addition, the intracellular radionuclide uptake was quantified. Single-cell dose calculations were based on Monte Carlo simulations performed using Geant4. RESULTS: Compared with external radiation using x-rays (D37 = 2.6 Gy), the radionuclides (99m)Tc (D37 = 3.5 Gy), and (123)I (D37 = 3.8 Gy) were less toxic in the presence of perchlorate. In the absence of perchlorate, the amount of activity a37 that was necessary to reduce the surviving fraction (SF) to 0.37 was 22.8 times lower for (99m)Tc and 12.4 times lower for (123)I because of the dose increase caused by intracellular radionuclide accumulation. When the cell nucleus was considered as the target for the dose calculation, the authors found a RBE of 2.18 for (99m)Tc and RBE = 3.43 for (123)I. Meanwhile, regarding the dose to the entire cell, RBE = 0.75 for (99m)Tc and RBE = 1.87 for (123)I. The dose to the entire cell was chosen as the dose criterion because of the intracellular radionuclide accumulation, which was found to occur solely in the cytoplasm. The calculated number of intracellular decays per cell was (975 ± 109) decays/MBq for (99m)Tc and (221 ± 82) decays/MBq for (123)I. CONCLUSIONS: The authors' data indicate that extra-nuclear targets to Auger electrons exist, which is obvious from our dose calculations. When considering the dose to the cell nucleus, the authors found an enhanced RBE for(99m)Tc and (123)I relative to acute x-ray irradiation and pure extracellular irradiation with both radionuclides. Surprisingly, the authors did not find any radionuclide accumulation in the cell nucleus, indicating that there are additional radiosensitive targets besides the DNA. In addition, the authors demonstrated the necessity of cellular dose calculations in radiobiological experiments using unsealed radionuclides and identified the relevant parameters.

Management program decreases postoperative nausea and vomiting in high-risk and in general surgical patients: a quality improvement cycle.

BACKGROUND: Preventing postoperative nausea and vomiting (PONV) is a major priority for postsurgical patient care. Our objective was to assess the efficacy of a multimodal postoperative nausea and vomiting (PONV) approach, which was associated with a continuous quality improvement program, in maintaining a low PONV incidence in the PACU. METHODS: Consecutive adult patients scheduled for surgery (ambulatory surgery or not) were prospectively included. PONV data were recorded in the PACU and over a 24-hour period. The management program was based on a multimodal approach with both changes in anesthetic techniques and anti-emetics, and on a three-stage protocol including: 1) phase I: institutional practice phase based on prospective observational study; 2) protocol implementation; 3) phase II: prospective observational study associated with feedback, scientific session and evaluation to guideline adherence. We used the Apfel risk scoring system to identify patients at high risk of PONV. Feedback with audit results and didactic sessions were scheduled quarterly in the Phase II. RESULTS: Thirty-seven/395 (9.4%) and 151/3864 (3.9%) patients experienced PONV in the PACU during Phase I and Phase II respectively (P<0.001). Among the patients with an Apfel risk score that included at least two risk factors, 16.6% and 4.2% experienced PONV in the PACU during Phase I and Phase II respectively (P<0.001). CONCLUSION: We highlight the association with a sharp decrease in PONV incidence over a one-year period and a multimodal PONV approach using feedback to clinicians associated with continuous quality improvement program.

Operative treatment and outcome of unstable distal radial fractures using a palmar T-miniplate at a non-specialized institution.

Treatment options for displaced distal radial fractures are still a controversial topic of discussion. Although good results for the palmar plating of high-volume centers have been published, evidence of its successful use in smaller institutions is still lacking. We report the clinical and radiological results of the treatment for 84 distal radial fractures with a single 2.4-mm T-miniplate in an institution performing <30 procedures per year. According to the AO classification system, there were 30 A, 5 B, and 49 C fractures with a patients mean age of 64 years. After a minimum of 12-month follow-up, we found very good and good results according to the Gardland and Sarmiento scores and a DASH of 5.6. Only five patients were classified as having a moderate outcome. A remaining intra-articular step-off of more than 1 mm was seen in 15 patients. In a comparison of grip strength between the injured and uninjured hands, we saw a difference of 6.8 % less on the injured side. We saw two instances of tendon rupture and one of tendon irritation due to prominent dorsal screws and necessitating revision surgery. Flexor tendon irritation was noted in one patient, requiring a second operation. Modern treatment for distal radial fractures can be performed successfully and with good clinical outcome in smaller institutions. Based on the high and increasing incidence of distal radial fractures, there is no need to transfer these patients into high-volume centers. Level of evidence Case study, Level IV.

[Changes of heat shock proteins content in the gill epithelium cells of mussel Mytilus edulis L. depending upon the salinity of medium].

The composition and the level of heat shock (stress) proteins content were studied by the method of immunobloting in the gill epithelium cells of mussels Mytilus edulis L. from the White sea, treated by water of different salinities. Stress proteins of about 70 and 40 kDa were revealed at Western blots. After long-term (11-14 days) acclimation to 14 and 35 per thousand the level of Hsp70 in gill epithelium cells increased to compare with that in control mussels. Hsp70 induction was observed in the cells of isolated gills after salinity shock at 14 per thousand during 3 and 24 hours.

Nutritional risk score is not sensitive enough to predict weight loss in diseased elderly subjects.

OBJECTIVES: malnutrition is highly prevalent in diseased elderly people, especially in hospital departments, and weight loss also occurs during hospital stays. Among the tools proposed to define malnutrition and to screen persons at risk of malnutrition, the nutritional risk score (NRS) has been suggested as a simple tool. DESIGN AND PARTICIPANTS: the aim of the present study was to test the validity of the NRS to predict weight changes 3 months after discharge. NRS and visual analogue scales for hunger, early satiety, thirst, fatigue and pain were performed in 106 patients aged 65 yrs and over, 67 treated for cancer, without overt malnutrition. RESULTS: forty six patients lost more than 1 kg. None of the parameters tested was correlated with weight changes, except NRS which was weakly correlated (r=-0.22, P=0.037). However a 0 score at NRS was associated with weight changes ranging -9 to +5 kg. Furthermore, the 11 patients with a high NRS score and weight loss were in a clinical situation that made it very likely that they would lose weight. In conclusion, NRS is not a valid score to predict weight change.

Semiconductor waveguide source of counterpropagating twin photons.

We experimentally demonstrate an integrated semiconductor source of counterpropagating twin photons in the telecom range. A pump beam impinging on top of an AlGaAs waveguide generates parametrically two counterpropagating, orthogonally polarized signal/idler guided modes. A 2 mm long waveguide emits at room temperature one average photon pair per pump pulse, with a spectral linewidth of 0.15 nm. The twin character of the emitted photons is ascertained through a time-correlation measurement. This work opens a route towards new guided-wave semiconductor quantum devices.

[Cations in molluscan tissues at sharply different hemolymph osmolality].

Experiments on different bivalve and gastropod species living in fresh, brackish, and sea water of different salinity demonstrated a direct correlation between the osmolality of the hemolymph and interstitial fluid and the concentration of sodium ions in it. A direct correlation between the osmolality of the interstitial fluid and the content of potassium and magnesium ions in the tissues (adductor and foot) was revealed. The significance of physicochemical indices of the environment and formation of eukaryotic cells at the initial stages of animal evolution are discussed.