ABSTRACT
Every medical student is confronted with death at some point in his/her career. This inevitable experience is often accompanied by intense emotions, both enriching and painful. However, too little attention is paid to these aspects during the training course, and the support given to students by their trainers is often uncertain. We will discuss these aspects here, along with a few ideas for improvement, based on the international literature and our own experience in the field.
Toute étudiante en médecine est, à un moment ou un autre de son parcours, confrontée à la mort. Cette expérience inévitable est bien souvent accompagnée d'intenses émotions, enrichissantes ou douloureuses. Ces aspects sont cependant trop peu abordés durant le cursus de formation, parallèlement à un accompagnement bien souvent aléatoire des étudiantes par leurs formateurs-trices. Nous évoquons ici ces aspects ainsi que quelques pistes d'amélioration, en nous basant sur la littérature internationale et notre expérience de terrain.
Subject(s)
Death , Students, Medical , Humans , Students, Medical/psychologyABSTRACT
The care of patients suffering from a borderline personality disorder confronted with death is a relational and clinical challenge for interdisciplinary teams. In this specific context, the particular psychic vulnerability of these patients highlights multiple issues. Based on the scarce existing literature and our clinical experience, this article presents management strategies in order to best support this population weakened by serious illness as well as the interdisciplinary teams that care for them.
La prise en soins de patients souffrant d'un trouble de la personnalité borderline confrontés à la mort est un défi relationnel et clinique pour les équipes interdisciplinaires. Dans ce contexte particulier, la vulnérabilité psychique de ces patients met en lumière de multiples enjeux. Cet article propose, sur la base de la rare littérature existante et de notre expérience clinique, des stratégies de prise en soins afin d'accompagner au mieux cette population fragilisée par la maladie grave ainsi que les équipes interdisciplinaires qui en prennent soin.
Subject(s)
Borderline Personality Disorder , Humans , Borderline Personality Disorder/therapy , DeathABSTRACT
This article focuses on the recommendations and issues of artificial nutrition (AN) in advanced palliative situations. In oncological situations, stages of cachexia and performance indexes help guide the decision-making process regarding the indications for AN. AN is usually not recommended in low performance indexes (Karnofsky ≤50 %, ECOG ≥ 3) nor in refractory cachexia. In some cases, a time-limited therapeutic trial may be suggested, with its effectiveness assessed by measurable goals. In advanced dementia, AN is not recommended. Often at the source of an AN request, the emotional aspect deserves to be explored in order to assess the patient's and his/her family's expectations and fears.
Cet article s'intéresse aux recommandations et aux enjeux de la nutrition artificielle (NA) en situation palliative avancée. En situation oncologique, les stades de cachexie et les indices de performance permettent d'orienter le processus décisionnel quant aux indications de la NA. Cette dernière est en général contre- indiquée lors d'indice de performance bas (Karnofsky ≤ 50 %, ECOG/ Eastern Cooperative Oncology Group ≥ 3) et lors de cachexie réfractaire. Dans certains cas, un essai thérapeutique d'un temps limité peut être proposé, dont l'efficacité est évaluée par des objectifs mesurables. En situation de démence avancée, la NA n'est pas recommandée. Souvent à l'origine d'une demande de NA, l'aspect émotionnel mérite d'être exploré afin d'évaluer les angoisses et les (faux) espoirs du patient et de ses proches.
Subject(s)
Dementia , Dementia/therapy , Female , Humans , Male , Nutritional Status , Palliative Care/methodsABSTRACT
Alterations in the generation, migration and integration of different subtypes of neurons in the medial prefrontal cortex (mPFC) microcircuit could play an important role in vulnerability to schizophrenia. Using in vivo cell-type specific manipulation of pyramidal neurons (PNs) progenitors, we aim to investigate the role of the schizophrenia risk-gene DiGeorge Critical Region 2 (Dgcr2) on cortical circuit formation in the mPFC of developing mice. This report describes how Dgcr2 knock down in upper-layer PNs impacts the functional maturation of PNs and interneurons (INs) in the mPFC. First, we demonstrate that Dgcr2 knock-down disrupts laminar positioning, dendritic morphology and excitatory activity of upper-layer PNs. Interestingly, inhibitory activity is also modified in Dgcr2 knock-down PNs, suggesting a broader microcircuit alteration involving interneurons. Further analyses show that the histological maturation of parvalbumin (PV) INs is not dramatically impaired, thus implying that other INs subtypes might be at play in the reported microcircuit alteration. Overall, this study unravels how local functional deficits of the early postnatal development of the mPFC can be induced by Dgcr2 knock-down in PNs.
Subject(s)
Platelet Glycoprotein GPIb-IX Complex/metabolism , Schizophrenia , Animals , Down-Regulation , Interneurons/metabolism , Mice , Parvalbumins/genetics , Parvalbumins/metabolism , Prefrontal Cortex , Schizophrenia/geneticsABSTRACT
Death anxiety is a frequent symptom in patients in the palliative phase of their disease, yet it is rarely explored. Several obstacles are responsible for this undervaluation including some on the medical side. For example: the fear of hurting the patient's feelings, one's own representations and projections onto patients. The lack of exploration and consequently the lack of support can have a dramatic impact on patients' quality of life. So, as to do the right thing, how should one act? This paper will, based on the literature and experience, explore some of the different avenues to help primary care physicians overcome this taboo.
L'angoisse de mort est un symptôme très fréquent et rarement évalué chez les patients en phase palliative de leur maladie. Plusieurs obstacles, notamment du côté médical, sont à l'origine de cette sous-évaluation, comme, par exemple, la peur de heurter, les représentations et les projections sur le patient. L'absence d'évaluation et par conséquent le manque d'accompagnement peuvent avoir un impact dramatique sur sa qualité de vie. Comment faire pour bien faire ? Basées sur la littérature et l'expérience, quelques pistes de réflexion sont explorées dans cet article pour aider le praticien à dépasser ce tabou.
Subject(s)
Quality of Life , Taboo , Anxiety , Fear , Humans , Palliative CareABSTRACT
The death of a patient taking opioids can generate strong feelings of guilt. « Have I hastened my patient's death by my administration of opioids ? ¼ Doubts may arise in certain situations, despite the proven safety of appropriate opioid use in the management of dyspnea and pain in the palliative care setting. Fearing the harms of opioid administration, some medical practitioners may undertreat patients, forsaking them to suffering. Other doctors, desperate to relieve their excruciating suffering at all cost, may in fact have recourse to euthanizing acts. This article seeks to answer this ethical dilemma with an overview of the double effect principle.
La mort d'un patient en situation palliative sous opioïde génère parfois un fort sentiment de culpabilité. « Ai-je précipité le décès du patient avec mon traitement opioïde ? ¼ Bien que la littérature soit très claire quant à la sécurité des opioïdes utilisés correctement pour la gestion de la dyspnée ou de la douleur en soins palliatifs, il se peut que, dans certaines situations, on puisse en douter. Le médecin, face à sa crainte de nuire en administrant des opioïdes, pourrait être tenté de sous-traiter le patient, au risque de l'abandonner à sa souffrance. D'un autre côté, l'impuissance face à l'intensité de la souffrance du patient pourrait amener le médecin à vouloir le soulager à tout prix, au risque d'un geste euthanasiant. Cet article propose un aperçu du principe du double effet, comme élément de réponse à ce dilemme éthique.
Subject(s)
Analgesics, Opioid , Palliative Care , Death , Double Effect Principle , Humans , Pain/drug therapyABSTRACT
After many decades of intense research in low-coordinate phosphorus chemistry, the advent of Na[OCP] brought new stimuli to the field of CHOP isomers and derivatives thereof. The present theoretical study at the CCSD(T)/def2-TZVPP level describes the chemical space of CHOP isomers in terms of structures and potential energy surfaces, using oxaphosphirene as the starting point, but also covering substituted derivatives and COP- isomers. Bonding properties of the Pâ»C, Pâ»O, and Câ»O bonds in all neutral and anionic isomeric species are discussed on the basis of theoretical calculations using various bond strengths descriptors such as WBI and MBO, but also the Lagrangian kinetic energy density per electron as well as relaxed force constants. Ring strain energies of the superstrained 1H-oxaphosphirene and its barely strained oxaphosphirane-3-ylidene isomer were comparatively evaluated with homodesmotic and hyperhomodesmotic reactions. Furthermore, first time calculation of the ring strain energy of an anionic ring is described for the case of oxaphosphirenide.
Subject(s)
Computer Simulation , Models, Molecular , Phosphorus Compounds/chemistry , Isomerism , Quantum Theory , Structure-Activity RelationshipABSTRACT
La presente investigación es un aporte a la comprensión de la infancia y del maltrato infantil. Se llevó a cabo un estado del arte del conocimiento producido en las experiencias de investigación/intervención realizadas en el marco del Programa de Especialización en Prevención del Maltrato Infantil de la Universidad Javeriana, entre los años 2002 al 2006. El artículo recrea la actualidad de esta preocupación en Colombia, ofrece reinterpretaciones al discurso construido, y plantea un marco para el análisis complejo del maltrato dentro de las relaciones entre adulto y niño...
This research is a contribution to the understanding of childhood and the child maltreatment within the framework of the state of the art of the knowledge produced in the experiences of research / intervention carried out under the Specialization Program on Child Maltreatment Prevention of Javeriana University, between 2002 to 2006. The article recreates the outstanding of this concern in Colombia, offers reinterpretations to the speech built and poses some bases to analyze the child maltreatment from the perspective of the adult-child relationships...
Subject(s)
Child , Child Abuse/psychologyABSTRACT
In order to assess the effects of displacement and exposure to violence on children's moral reasoning, Colombian children exposed to minimal violence (non-displaced or low-risk) (N = 99) and to extreme violence (displaced or high-risk) (N = 94), evenly divided by gender, at 6-, 9-, and 12 - years of age, were interviewed regarding their evaluation of peer-oriented moral transgressions (hitting and not sharing toys). The vast majority of children evaluated moral transgressions as wrong. Group and age differences were revealed, however, regarding provocation and retaliation. Children who were exposed to violence, in contrast to those with minimum exposure, judged it more legitimate to inflict harm or deny resources when provoked and judged it more okay to retaliate for reasons of retribution. Surprisingly, and somewhat hopefully, all children viewed reconciliation as feasible. The results are informative regarding theories of morality, culture, and the effects of violence on children's social development.
