[Multidisciplinary Team Meeting dedicated to geriatric oncology: Decisions and four month follow-up]. / RCP dédiée à l'onco-gériatrie : décisions et suivi à quatre mois.

INTRODUCTION: MTDM dedicated to geriatric oncology are held at the E. Herriot hospital in Lyon. They bring together oncologist and geriatrician to optimize, through their complementary expertise, the care plan for elderly cancer patients. The aim is to demonstrate the value of these MTDMs and to describe the follow-up of oncological and geriatric recommendations. METHODS: This is a descriptive, prospective, non-interventional study analyzing the MTDMs dedicated to patients over 70years old with cancer. All patients underwent a comprehensive geriatric assessment (CGA) with a four-month follow-up. RESULTS: One hundred twenty-one patients were included with a G8 score≤14 (93 %), a slightly diminishing independence ADL<6 (36%) and IADL<4 (42%). The median CIRS-G is eight with on average, three geriatric syndromes/patient. Most cancers are non-metastatic. When oncological treatment is recommended (80 %), it is mostly curative (58 %). Geriatric recommendations were made for 75 % of patients. At four months, four patients were lost to follow-up and 34 died. No significant change in the dependency level was found. In 75 % of cases, at least one geriatric recommendation were followed and 77 % of oncological recommendations. CONCLUSION: The recommendations could be followed at four months; they were carried out in a comparable way whether they were oncological or geriatric. These MTDMs specializing in geriatric oncology appear to be beneficial in the geriatric oncology decision-making process. It is important to continue and strengthen this co-management.

[Red blood transfusion in palliative care situation]. / Transfusion de globules rouges en situation oncologique palliative.

Anemia is frequent in oncology. We debate the decision-making process of erythrocyte transfusion in palliative care situation from a case report. A patient with a prostatic metastatic cancer was in palliative situation with asthenia and coronary symptom. We analyze, in this particular case that does not describe reality of normal practice, the decision-making process of erythrocyte transfusion. These transfusions were based, in this case, on the evaluation of oncology prognosis, the short-term vital threats, life project and clinical safety of the transfusion. The patient has received 5 erythrocyte transfusions in 4 months until a multidisciplinary meeting decided to stop transfusion because of poor prognostic situation and bad tolerance of the act. This patient could be a collegial model used to measure the reasonable nature of prescription depending on the purpose and the goal of the patient but does not allow generalization. Although there is low risk of erythrocyte shortage, it seems important to train doctors to reduce abusive transfusion and define transfusion thresholds. Different levels of erythrocyte transfusion security would raise the issue of management of several stocks. Erythrocyte transfusion in palliative care can be considered subject to prognostic information and the palliative aim of the transfusions, multidisciplinary decision-making, during short hospitalizations and with evaluation of the act and consequences for the patient.

[Decision of emergency involuntary hospitalization: categorical or dimensional approach?]. / La décision d'hospitalisation sans consentement aux urgences: approche dimensionnelle ou catégorielle?

BACKGROUND: In 2005, in its recommendations on the modalities of decision making for compulsory hospitalization, the French Health High Authority (HAS) had already stressed the need for rapid implementation of studies and epidemiological analyses on the subject to compensate the lack of adequate data in France. The new French law of July 5, 2011, on the rights and protection of persons under psychiatric care, establishes a judicial review of decisions for compulsory hospitalization. Therefore, healthcare professionals need to better define and characterize the criteria for such decisions, especially in their relation to psychopathology. The concept of capacity to consent to treatment includes the ability to understand (to receive information about the disease), the ability to appreciate (to weigh the risks and benefits of treatment), the ability to reason (determining the best choice rationally) and the ability to freely express a decision. However, assessment tools of capacity to consent to treatment seem to fail to predict the modality of hospitalization. OBJECTIVE: This study examined the impact of clinical and contextual characteristics on the decision in emergency services to admit patients to compulsory inpatient psychiatric units. METHOD: Data was collected from 442 successive patients admitted to hospital for care from five psychiatric emergency facilities in Paris and covered sociodemographic information, previous hospitalizations, recent course of care, clinical diagnosis, Global Assessment of Functioning scale (GAF) and Insight measured by the Q8 Bourgeois questionnaire. Patients were also assessed based on criteria established by the HAS for the severity of mental disorders and the necessity of emergency care. RESULTS: Multivariable logistic regression shows that diagnosis does not affect the decision of hospitalization. Agitation, aggressiveness toward others, being married as well as being referred by a doctor or family are all factors that increase the risk of involuntary hospitalization. Last, low Q8 and GAF scores are strong predictors for compulsory admission. CONCLUSION: Our study shows a dimensional rather than categorical assessment of patients by clinicians. Assessment of insight is the main operational criterion used by clinicians in our study. This supports using insight and GAF evaluation in clinical practice to clarify assessment and decision-making in an emergency setting regarding compulsory hospitalization.

Construção democrática e modelos de Constituição / Democracy-building and constitutional models / Construction démocratique et modèles de constitution

This article makes a theoretical contribution to the comparative analysis of constitutional choices in new democracies, particularly those related to the profile of constitutions, reform and amendment political processes, and legal review and legal interpretation. The constitution itself is viewed as an object of research and analysis. Special attention is dedicated to the case of policy-oriented constitutions and their impact on the submission of government and public policy agendas. The constitutionalization of public policies is viewed as an additional veto point in the political system. Since different constitutional patterns engender distinct decision-making processes, the study examines how the related costs affect government efficiency and jeopardize democratic representation.

Dans cet article, on propose un apport théorique à l'analyse comparative de choix constitutionnels pour les nouvelles démocraties, surtout ceux qui concernent les constitutions, les processus politiques de réforme et d'amendement ainsi que les processus de révision et d'interprétation juridiques. La constitution y est considérée comme un objet en soi d'investigation et d'analyse. On examine surtout le cas de constitutions de politiques dirigées et leur impact sur la préparation de programmes gouvernementaux et sur les politiques publiques. La constitutionnalisation de politiques publiques est envisagée comme un nouveau point d'opposition du système politique. Sachant que différents modèles constitutionnels engendrent des processus de décision divers, on examine ici comment leurs coûts affectent l'efficacité gouvernementale et gênent la représentation démocratique.

Continuidades e descontinuidades da Federação Brasileira: de como 1988 facilitou 1995 / Continuités et discontinuités de la Fédération Brésilienne: comment 1988 a rendu 1995 plus facile / Continuities and discontinuities in the Brazilian Federation: how 1988 made 1995 possible

The article shows that the drafters of the 1988 Brazilian Constitution approved political institutions that combine broad jurisdictional authority to the Federal government along with limited institutional veto powers to subnational governments. The study has examined 59 initiatives of legislation addressing federal matters voted by the Chamber of Deputies from 1989 to 2006. The article explores how political institutions affect the decision-making process of federal issues, by distinguishing main actors´ preferences from federal institutions, controlled by presidential terms.

Dans cet article, on cherche à montrer que les responsables de la Constitution brésilienne de 1988 ont créé un modèle d'État federal qui associe une large autorité juridictionnelle à l'État central avec des possibilités institutionnelles assez limitées de veto aux gouvernements subnationaux. L'etude tien pour base l'examen des 59 initiatives en matière d'intérêt federal soumises au Congrès national de 1989 à 2006. On y examine les déterminants fédératifs du processus décisionnel, tout en faisant la distinction entre les préférences explicites des principaux acteurs et l'effet des institutions fédératives, contrôlées par mandat présidentiaux.