Spine surgeons facing second opinions: a qualitative study.

BACKGROUND CONTEXT: The social and technological mutation of our contemporary period disrupts the traditional dyad that prevails in the relationship between physicians and patients. PURPOSE: The solicitation of a second opinion by the patient may potentially alter this dyad and degrade the mutual trust between the stakeholders concerned. The doctor-patient relationship has often been studied from the patient's perspective, but data are scarce from the spine surgeon's point of view. STUDY DESIGN/SETTING: This qualitative study used the grounded theory approach, an inductive methodology emphasizing field data and rejecting predetermined assumptions. PATIENT SAMPLE: We interviewed spine surgeons of different ages, experiences, and practice locations. We initially contacted 30 practitioners, but the final number (24 interviews; 11 orthopedists and 13 neurosurgeons) was determined by data saturation (the point at which no new topics appeared). OUTCOME MEASURES: Themes and subthemes were analyzed using semistructured interviews until saturation was reached. METHODS: Data were collected through individual interviews, independently analyzed thematically using specialized software, and triangulated by three researchers (an anthropologist, psychiatrist, and neurosurgeon). RESULTS: Index surgeons were defined when their patients went for a second opinion and recourse surgeons were defined as surgeons who were asked for a second opinion. Data analysis identified five overarching themes based on recurring elements in the interviews: (1) analysis of the patient's motivations for seeking a second opinion; (2) impaired trust and disloyalty; (3) ego, authority, and surgeon image; (4) management of a consultation recourse (measurement and ethics); and (5) the second opinion as an avoidance strategy. Despite the inherent asymmetry in the doctor-patient relationship, surgeons and patients share two symmetrical continua according to their perspective (professional or consumerist), involving power and control on the one hand and loyalty and autonomy on the other. These shared elements can be found in index consultations (seeking high-level care/respecting trust/closing the loyalty gap/managing disengagement) and referral consultations (objective and independent advice/trusting of the index advice/avoiding negative and anxiety-provoking situations). CONCLUSIONS: The second opinion often has a negative connotation with spine surgeons, who see it as a breach of loyalty and trust, without neglecting ego injury in their relationship with the patient. A paradigm shift would allow the second opinion to be perceived as a valuable resource that broadens the physician-patient relationship and optimizes the shared surgical decision-making process.

[Prevalence of mental disorders in French prisons: A systematic review]. / Prévalence des troubles psychiatriques en population carcérale française : une revue systématique de la littérature.

INTRODUCTION: The prevalence of psychiatric disorders among prisoners remains a major public health issue worldwide. In France, despite the increasing number of persons who are incarcerated (+30% between 1992 and 2002 with a 120% prison overcrowding), and a historical concern about the mental health of persons in detention and its management, no systematic review has been published on this subject. The aim of this article is to present the results of a systematic review of the literature on the prevalence of psychiatric disorders in French prisons. METHOD: The reporting of this systematic review conforms to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist. We searched the PubMed and Web of Science databases. We used combinations of keywords relating to prison (prison*, jail*, inmate*), to psychiatry ("mental health", psychiatr*), and to France (France, French). This work was completed with a search through the digital libraries of the École des Hautes Études en Santé Publique (EHESP) and of the Système Universitaire de Documentation (Sudoc) to obtain data from academic works and the gray literature. References cited in studies included in this review were also examined. All references published up to September 2022, written in English or French, presenting the results of original quantitative studies on the prevalence of psychiatric disorders in correctional settings were included. Two researchers independently extracted data from included references according to a pre-established protocol. RESULTS: Among 501 records identified, a total of 35 papers based on 24 epidemiological studies met the eligibility criteria for inclusion in this review: 16 were cross-sectional, 7 retrospective and 1 both cross-sectional and retrospective. All papers were published between 1999 and 2022. We found one European study, 5 international studies, 18 regional or local studies. Of these, 21 studies had all-male or mixed gender samples (but when the sample was mixed gender, it was always at least 92% male). Almost half of the studies (n=11) involved a small sample of fewer than 500 persons. Half of the studies involved a sample of recently incarcerated persons: 6 involved a random sample of persons in detention, and 1 involved a sample of people incarcerated for more than 5 years. The last 5 studies focused on persons aged over 50 years and incarcerated for more than one year (n=1), incarcerated for sexual offences (n=2), placed in disciplinary cells (n=1) or in a special wing for radicalized or suspected radicalized individuals (n=1). Nine studies used standardized and validated diagnostic tools. According to the 4 studies involving representative samples and using standardized and validated diagnostic tools, the prevalence of the following psychiatric disorders was: 29.4-44.4% for anxiety disorders, 5-14.2% for PTSD, 28-31.2% for mood disorders, 6.9-17% for psychotic disorders, 32% for personality disorders and 11% for ADHD. CONCLUSION: This systematic review of the literature highlights the high prevalence of psychiatric disorders in French prisons. The data collected are in line with international studies. The great methodological heterogeneity of the papers included in this review calls for further rigorous research to better understand the rates of mental disorders in French prisons and to explore their determinants.

Becoming a neurosurgeon in France: A qualitative study from the trainees' perspective.

Introduction: The training of neurosurgeons is evolving in a world of socio-professional changes, including the technological revolution, administrative pressure on stakeholders, reduced working hours, geographical heterogeneity, generational changes, to name but a few. Research question: This qualitative study aimed to explore experiences and feedback of French neurosurgical trainees concerning their training. Material and methods: The grounded theory approach was used with 23 neurosurgical trainees' interviews. Inclusion was continued until data saturation. Six researchers (an anthropologist, a psychiatrist, and four neurosurgeons) thematically and independently analyzed data collected through anonymized interviews. Results: Data analysis identified three superordinate themes: (1) The Trainee-Senior Dyad, where the respondents describe a similar bipolarity between trainees and faculty (trainees oscillating between those who fit into the system and those who are more reluctant to accept hierarchy, faculty using an ideal pedagogy while others refuse to help or invest in training); (2) The difficulty to learn (describing pressure exercised on trainees that can alter their motivation and degrade their training, including the impact of administrative tasks); (3) A pedagogy of empowerment (trainee' feelings about the pertinent pedagogy in the OR, ideal sequence to progress, progressive empowerment especially during the shifts, and stress of envisioning themselves as a senior neurosurgeon). Discussion and conclusion: Respondents emphasize the heterogeneity of their training both intra- and inter-university-hospital. Their critical analysis, as well as the formalization of their stress to become autonomous seniors, can be an important link with the reforms and optimizations currently being carried out to improve and standardize the training of young French neurosurgeons.

International guidelines for the prevention of sexual violence: A systematic review and perspective of WHO, UN Women, UNESCO, and UNICEF's publications.

BACKGROUND: Sexual violence is a major public health issue worldwide, with a high prevalence and extensive human and financial costs. Implementing prevention programs is complex, requiring not only evidence-based practices and high ethical standards, but also close collaboration with local governments and non-governmental organizations. In order to guide and support all stakeholders necessary to achieve large-scale prevention (e.g., politicians, decision-makers, in-field professionals), it is essential to establish international benchmarks for the prevention of sexual violence. OBJECTIVE: The main goal of this collaborative study was to conduct a systematic review of the frameworks adopted by WHO, UN Women, UNESCO, and UNICEF to help prevent sexual violence worldwide, according to the PRISMA methodology. A secondary objective was to highlight the levels of prevention and determinants of health targeted by these organizations. RESULTS: Overall, 1008 references were identified, of which 50 met the inclusion criteria. All international guidelines were limited to primary or tertiary prevention, and they were not specifically dedicated to sexual violence. In addition, each organization had developed idiosyncratic prevention strategies. Common primary prevention determinants of health were still found across organizations, including education, socio-economic inequalities, and life skills training. Tertiary prevention was poorly developed and polarized between victims and perpetrators. Secondary prevention was never addressed, however, despite the effectiveness of approaches such as helplines for people sexually attracted to children. DISCUSSION: Given these results, an international French-speaking consortium of professional teams, all involved in the secondary prevention of sexual violence, was recently formed with a ratified charter presented here.

[Health needs and organization of care in prison]. / Besoins sanitaires et organisation des soins en 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 care in specially equipped hospital units]. / Les soins psychiatriques en unités hospitalières spécialement aménagées.

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.

Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practice-a qualitative study.

BACKGROUND: The judicialization of medicine can lead to professional disenchantment and defensive attitudes among surgeons. Some quantitative studies have investigated this topic in spine surgery, but none has provided direct thematic feedback from physicians. This qualitative study aimed to identify the impact of this phenomenon in the practice of spine neurosurgeons. METHODS: We proposed a qualitative study using grounded theory approach. Twenty-three purposively selected private neurosurgeons participated. Inclusion took place until data saturation was reached. Data were collected through individual interviews and analyzed thematically and independently by three researchers (an anthropologist, a psychiatrist, and a neurosurgeon). RESULTS: Data analysis identified five superordinate themes that were based on items that recurred in interviews: (1) private practice of spinal surgery (high-risk surgery based on frequent functional symptoms, in an unfavorable medicolegal context); (2) societal transformation of the doctor-patient relationship (new societal demands, impact of the internet and social network); (3) judicialization of spine surgery (surgeons' feelings about the frequency and motivation of the complaints they receive, and their own management of them); (4) coping strategies (identification and solutions for "at risk" situations and patients); and (5) professional disenchantment (impact of these events on surgeons' daily practice and career planning). Selected quotes of interviews were reported to support these findings. CONCLUSIONS: Our study highlights several elements that can alter the quality of care in a context of societal change and the judicialization of medicine. The alteration of the doctor-patient relationship and the permanent pressure of a possible complaint encourage surgeons to adopt defensive attitudes in order to minimize the risks of litigation and increased insurance premiums. These phenomena can affect the quality of care and the privacy of physicians to the extent that they may consider changing or interrupting their careers earlier.

Month of birth, a risk factor for violent behaviour in suicidal patients admitted in emergency?

Although there are numerous publications on the existing link between month of birth and suicide, only two studies focus on suicide attempts and auto-aggressive behavior. Research data suggest that month of birth is related to a variation of 5-HIAA in the cerebrospinal fluid, which correlates with violent behavior (VB). Therefore, the aim of this study is to search, for the first time, for a possible link between month of birth and the occurrence of VB in emergency, for patients admitted for a suicide attempt with medication. This is a 10 months prospective study among all the patients of the canton of Geneva, Switzerland, admitted in emergency for a suicide attempt with medication. During a 10 months study period we included 493 patients, of which 77 (15.62%) presented VB. Higher incidence of VB was found in subjects where born at the end of winter and the beginning of spring, with a maximum for April and a minimum for December. In spite of a relatively small number of subjects, it seems promising to study the occurrence of VB as a function of month of birth in patients admitted in emergency for a suicide attempt.

Violent behavior of patients admitted in emergency following drug suicidal attempt: a specific staff educational crisis intervention.

OBJECTIVE: In spite of much effort to create guidelines on the management of violent behavior (VB) in emergency departments, little is known about the impact of such guidelines on a real-life emergency environment. The aim of this study is to investigate the impact of a staff educational crisis intervention (SECI) on the reduction of VB in patients admitted to emergency departments following drug suicidal attempt. METHOD: The impact of a SECI on VB of patient consulting the ER following a drug suicide attempt was assessed by comparing the occurrence of VB before (5 months) and after (5 months) the introduction of a SECI. RESULTS: A significant reduction in VB (from 17.32% to 7.14%) was found with the comparison of two 5-month periods: before (254 patients) and after (224 patients) the introduction of a SECI program (chi(2)=11.238; P=.0008). CONCLUSION: These preliminary data suggest the need for further prospective randomized studies aiming to prevent VB in emergency departments by developing specific SECI programs.