[The transformation process among a group of heart patients followed in ergotherapy with the aim of modifying the balance of occupation]. / Processus de transformation chez un groupe de personnes cardiaques suivies en ergothérapie pour une modification de leur équilibre du fonctionnement occupationnel.

Transformative learning is a process of adaptation that allows for profound personal change in occupational therapy clients. This process is provoked by a triggering factor, such as illness, which results in a critical reflection on values, beliefs, feelings and personal knowledge associated with the object of change (Mezirow, 1991). As part of an objective aimed at modifying the balance of occupation, nine participants were interviewed over a 6 month period to explore their processes of change. Eight concepts related to the objective of change of the balance of occupation emerged from an inductive data analysis process (Glaser and Strauss, 1967). The perception of work was interpreted by the authors as having undergone the most significant sense of transformation amongst the participants. Two other perceptions, 1) the definition of self and 2) the concept of health emerged as new elements essential to the modification of the balance of occupation. The transformation process linked to these eight concepts revealed a specific structure and sequence. The results highlight the primary role of critical reflection amongst occupational therapy clients and underline the importance of deconstructing common values and beliefs which could slow down the process of change. Moreover, the development of new values and beliefs is a vehicle for change in occupational therapy.

Occupational therapists' perceptions of evidence-based practice.

Occupational therapists are increasingly urged to carry out evidenced-based practice; however, little is known regarding their present practice and perceptions of evidence-based practice. To explore this phenomenon, a qualitative study was completed using a grounded theory approach. Semi-structured interviews were carried out with eight occupational therapists who worked in diverse practice settings. Participants were asked to reflect on their own views of evidence-based practice and their use of evidence in therapy. Data were analyzed inductively using constant comparison analysis. Participants' perceptions of evidence-based practice were described in three broad categories. To these occupational therapists, evidence-based practice is: (a) a process of looking for understanding; (b) associated with research, and; (c) a potential threat to the occupational therapist. These findings produce a basis from which recommendations are made to increase the use of evidence-based practice by occupational therapists.

[Jet intravenous injection of erythromycin lactobionate. A possible cause of the occurrence of crisis in torsade de pointe]. / Injection en flash intraveineux de lactobionate d'érythromycine. Une cause possible de survenue d'accès de torsade de pointe.

The authors report one case of torsade de pointe which occurred immediately after fast intravenous injection of a 1-gram dose of erythromycin lactobionate in a female patient who had undergone surgical replacement of the mitral and triscuspid valves 24 hours before. The responsibility of erythromycin was strongly suggested by the clinical data (syncope), electrocardiographic findings (electrocardiogram typical of torsade de pointe, slow rhythm and lengthened QT interval in the basal ECG) and the chronology of the sequence of intravenous injection of the antibiotic and the rhythm disorder. A literature search revealed six similar cases. Its seems that the arrythmogenic property of this drug is related to abnormally elevated serum levels following rapid administration.

[Shivering during recovery after cardiac surgery under extracorporeal circulation. Inconveniences and methods of prevention]. / Le frisson de réveil aprés chirurgie cardiaque sous C.E.C. inconvénients et moyens de prévention

Among 109 subjects who had undergone cardiac surgery under ECC, the authors recorded 50 (45 p. 100) who suffered from shivering during the coming round period. Comparing the series of patients who shivered, with that of the subjects who did not shiver, the authors demonstrate in the first case, an increase in cellular metabolism, the cardiac index, heart rate, central venous pressure and cardiac work. They subsequently note the apprearance of mixed acidosis and an increase in the lactate-pyruvate ratio. Certain patients, in whom the cardiac output did not keep up with the metabolic demand considerably increased the arterio-venous oxygen difference. Blood loss is increased as well as coagulation time showing a more intense heparin rebound. The study of the drugs used during anesthesia showed that the patients who had received chlorprotixene, as the neuroleptic, a neuroleptic with adrenolytic properties, had a very decreased frequency of shivering in comparison with those who had received droperidol. The placing of the patient at the end of the intervention on a heating mattress, combined with the administration of chlorprotixene during anesthesia, prevented the appearance of shivering.

[Anesthesia and the postoperative period in non-urgent tracheal surgery. Apropos of 36 patients]. / Anesthésie et suites opératoires en chirurgie trachéale non urgente. A propos de 36 malades

The authors report 36 cases of resection and suture for stenosis or tumour of the trachea and give details of their technique of anaesthesia, the post-operative follow-up and their results. The development of fiber endoscopy and simplification of intubation, increases the security of the patient, facilitates the task of the anaesthetist and thus improves greatly the operative conditions and post-operative period.