Illness representation and treatment beliefs in liver transplantation: an exploratory qualitative study.

BACKGROUND: The objective of this study was to gain detailed insight concerning liver transplanted patients' representations about transplantation, graft rejection and immunosuppressive drugs to adapt the educational follow-up. PATIENTS AND METHODS: Semi-structured interviews were conducted with 8 patients. Each interview was recorded and fully transcribed. The verbatim was first coded according to the themes of the Common Sense Model and an inductive approach for the remaining text. RESULTS: Transplantation is perceived both as a recovery and a new chronic condition. Participants feel powerless in the face of the risk of graft rejection. This risk is perceived as out of control as it is not associated with specific symptoms and external causes. The individual knowledge gained about transplantation relies on real-life experience shared between patients. Many participants feel anxiety. It responds to stress caused by immunosuppressant medication intake, routine check-ups, potential side effects and chronicity of immunodepression. Messages stressing the importance of the tacrolimus in the medication therapy are strengthened by a pre-discharge pharmaceutical consultation. DISCUSSION AND CONCLUSIONS: This study suggests that healthcare providers should systematically seek to determine illness representations to optimize the educational follow-up. The patient education program for liver transplanted patients should include three types of intervention: individualized education, behavioral intervention and psychological support. It should provide a support for stress management and acceptance of the new chronic condition. The involvement of a clinical pharmacist is relevant.

Evaluating counseling outcome on adherence to prophylaxis and follow-up after sexual HIV-risk exposure: a randomized controlled trial.

OBJECTIVE: Post-exposure prophylaxis (PEP) is recommended for the management of sexual HIV-risk exposure. However, a high percentage of exposed patients discontinue both their 28-day prophylaxis course before 15 days and HIV testing follow-up before M3. The objective of this study is to assess the efficacy of a counseling intervention in enhancing both adherence to PEP and HIV testing follow-up. METHODS: Between 1 June 2004 and 31 December 2005, 54 patients exposed to sexual HIV-risk exposure were included in a multicenter, prospective, controlled, randomized trial, comparing a group receiving a counseling intervention in addition to traditional medical management (intervention group (IG), n=28) vs. a control group (CG, n=26). Patients in the IG received interactive counseling interventions focused on adherence to PEP and to HIV testing follow-up, led by specially trained nurses. The main outcome measures were proportion of patients achieving 100% adherence to PEP as evaluated on D15 by a self-completed patient questionnaire and on HIV testing on D45 and M3. RESULTS: Groups were well balanced at baseline for age, sex, and circumstances of exposure. The proportion of 100% adherent patients to PEP was significantly higher in the IG compared to the CG (54% vs. 23%, p=0.036). Patients in the IG were more likely to complete the HIV testing follow-up at D45 (86% vs. 54%, p=0.023) and M3 (68% vs. 38%, p=0.056). CONCLUSIONS: This study suggests the effectiveness of a counseling program to enhance adherence to both PEP and HIV testing follow-up after sexual exposure.

[Ethics and handicap]. / Ethique et handicap.

The deprivation of numerous possibilities suffered by the severely-handicapped on account of their somato-psychic deficiency extends to many areas: mobility, relationships, autonomy in their everyday life, dependency, psychological or even mental consequences. The most elementary ethics would require to take all these deprivations into account, not just in the choice of accommodation structures but also in the behaviour of relatives and friends, or of qualified members of staff, in their approach to the handicapped. The range of application of these ethical rules must therefore extend from the quality of life and assistance, and the concern for efficiency of interventions, to the problems of security and securization, the assessment and the prevention of risks deriving from the handicap or its consequences, through the information of the patients regarding their elementary or specific rights, the introduction of the most favourable basis in order to make sure that they enjoy the dignity due to any human being, whatever his condition. Such a vast program requires a great many means of action, which all imply the recourse to the appropriate material and human assistance.

[Acute water intoxication after prolonged infusion of oxytocin]. / Intoxication aiguë par l'eau après perfusion prolongée d'ocytocine.

The authors report a case of acute water intoxication with severe neurological features which complicated prolonged administration of oxytocin for post-partum hemorrhage. The patient was a 35-year-old woman with a tight mitral stenosis. The patient recovered consciousness after the hydro-electrolytic state had been put right. The precautions that have to be undertaken and the monitoring that is necessary to avoid hyponatraemia with water retention are reviewed. It is important to know the risk factors which are connected with this treatment and how certain abnormal conditions of the heart can play a role in causing this syndrome.