[From psychiatric care to psychic care, for an ethic of restraint]. / Du soin psychiatrique au soin psychique, pour une éthique de la retenue.

This analysis of the ethical issues raised by the relationship between caregiver and patient is based on the history of psychiatry and sensitivity to the ethical tensions that run through the field of psychiatry and mental health. Taking a step back from the injunction to treat well, not fetishizing it, adopting a holistic approach, equipping ourselves to counter the stigmatization and self-stigmatization that so often accompany psychic and/or psychosocial disability, and inviting reflection on proportionality in mental health are all ethical priorities that are insufficiently invested in psychiatric clinics.

[Legal aspects of alternative methods to animal testing]. / Aspects juridiques des méthodes alternatives à l'expérimentation animale.

While the total replacement of animal experimentation was the goal set by the European Directive of 22 September 2010 on the protection of animals used for scientific purposes, it has to be said that it is still far from being achieved. The number of animals is not decreasing and alternative methods are struggling to be used. Under pressure from the citizens, the European Commission has just made new commitments to define the stages and specific actions to be put in place to reduce animal testing, a prerequisite for the transition to an animal-free regulatory system. Given the shortcomings and lack of coherence in European policy, mobilising the public is an essential lever for speeding up the implementation of alternative methods.

Title: Aspects juridiques des méthodes alternatives à l'expérimentation animale. Abstract: Si le remplacement total de l'expérimentation animale était l'objectif visé par la directive européenne du 22 septembre 2010 relative à la protection des animaux utilisés à des fins scientifiques, force est de constater qu'il est encore loin d'être atteint. Le nombre d'animaux ne diminue pas et les méthodes alternatives peinent à être utilisées. La Commission européenne, sous la pression citoyenne, vient de prendre de nouveaux engagements pour définir les étapes et les actions spécifiques à mettre en place pour réduire l'expérimentation animale, condition préalable à la transition vers un système réglementaire sans animaux. Entre dysfonctionnements et manque de cohérence dans la politique européenne, la mobilisation des citoyens représente un levier indispensable à l'accélération de la mise en œuvre des méthodes alternatives.

[Isolation and mechanical restraint in psychiatry]. / Isolement et contention mécanique en psychiatrie.

Since 2016, there has been a succession of legal texts aimed at framing the use of seclusion and mechanical restraint in psychiatric services. These legal evolutions are not without consequence on the practice of caregivers. We propose here a practical summary of this issue.

[Social support and accompaniment for patients with disabilities]. / Soutien et accompagnement social des patients en situation de handicap.

The announcement of multiple sclerosis is likely to turn a person's life and plans upside down. Many questions then arise, particularly concerning rights and available assistance. Faced with the multitude of existing organizations and mechanisms, caregivers can direct the patient to a social service assistant. This person will be able to advise and accompany the patient in his or her efforts.

[Rights and protection of the child victim of domestic violence]. / Droit et protection de l'enfant victime de violences conjugales.

Today, domestic violence is no longer seen as a matter for the couple. It is just as much a concern for children who are exposed to it, given the consequences it has for them. French law has taken up this issue by attempting to protect minors from violent situations while adequately punishing the perpetrator. The objective of the law is thus to put the child, a vulnerable person, at the center of the system.

[Positions adopted by children and their parents during mediated visits]. / Positionnements adoptés par les enfants et leurs parents lors des visites médiatisées.

Mediated visitation services welcome minors placed in a context of domestic violence. The parent-child relationship is then supported in an attempt to re-establish an intra-family balance that has been weakened and marked by trauma. When the work begins, the child is gradually put back at the heart of the concerns, in his or her place, and the parent regains confidence in himself or herself as well as in his or her parenting abilities. This is a complex and often long process.

[The role of the health executive with the residents in Ehpad]. / Le rôle du cadre de santé auprès des résidents en Ehpad.

The personalized quality support for residents of residential establishments for dependent elderly people, specified in the law of January 2, 2002, is implemented through various tools and regular evaluations. The health executive, as the central link in the chain, has a key role to play in carrying out these actions, which are part of a continuous quality improvement process.

[Long-term repaired tetralogy of Fallot : Echocardiographic parameters in correlation with cardiac MRI]. / Tétralogie de Fallot réparée au long terme : paramètres échographiques en corrélation avec l'IRM cardiaque.

INTRODUCTION: Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease. After surgical repair, the excellent survival rate has led to long-term complications dominated by pulmonary regurgitation (PR). Our study aimed to identify echocardiographic criteria for assessment of right ventricular (RV) function and quantification of PR correlated with cardiac MRI indices. METHODS: We conducted a descriptive study between June 2021 and March 2022 including patients followed for repaired ToF since 2016 or earlier. All patients were seen for clinical, electrocardiographic, and ultrasound evaluation. Cardiac MRI was performed with a maximum delay of 1 month from Doppler echocardiography. RESULTS: 38 patients were included, with a mean age at imaging of 18 ± 9 years. Our study showed that the echocardiographic parameters of PR quantification correlated with a pulmonary regurgitation fraction on MRI greater than 40% were: the PHT value (p = 0.005) and the ratio of PR jet width to pulmonary valve annulus diameter (p = 0.032). The only ultrasound parameter estimating RV systolic function correlated with RVEF on cardiac MRI was FAC, with p = 0.007. CONCLUSION: Quantitative assessment of RV parameters in patients followed for repaired ToF, as well as the assessment of the severity of PR, is feasible with a standardized ultrasound examination, with good correlation with cardiac MRI.

[Care pathways, care of the pathway: the underside of a debate]. / Parcours de soins, soins du parcours : les dessous d'un débat.

The coordinated care pathway consists of entrusting the attending physician with the coordination of care of the patient for the realization of medical follow-up with the ethical concern of a responsible consultation of the caregivers. This, so that medical practices and care devices are turned towards efficient care but also integrative, a qualitative search for life combining continuity of care and promotion of global health. This evolution towards greater respect for patients' rights requires that decisions taken be intelligently regulated in a context where caregiving interventions are still very prevalent and potentially intrusive in regard to the privacy of the persons being cared for.

[Arrhythmogenic right ventricular cardiomyopathy : An update]. / La cardiomyopathie arythmogène du ventricule droit : mise au point.

Arrhythmogenic right ventricular cardiomyopathy is a hereditary myocardial condition in most cases that affects the right ventricle, but also the left ventricle with variable degree. It predisposes patients to ventricular arrhythmia, heart failure and sudden death. Its diagnosis remains challenging and is mostly based on reference task-force criteria. The latter, divided between major and minor criteria, include structural abnormalities (visualized on echocardiography or cardiac magnetic resonance), electrocardiographic anomalies, ventricular arrythmia documentation, histological proof of fibro-fatty infiltrates within myocardial tissue and family history. Following a correct diagnosis, patient-tailored care is essential. First, implantation of an implantable cardioverter-defibrillator is recommended in case of history of sudden death, sustained ventricular tachycardia or advanced right/left ventricular dysfunction. It should be considered in case of cardiac syncope or non-sustained ventricular tachycardia. Secondly, eviction of high intensity physical activity is mandatory. Finally, beta-blockers are recommended for all patients with clinically manifest arrhythmogenic right ventricular cardiomyopathy.

A noção de afeto no direito de família: diálogo com a psicopatologia e a psicanálise / The notion of affect in family law: dialogue with psychopathology and psychoanalysis / La notion d'affect en droit de la famille: dialogue avec la psychopathologie et la psychanalyse / La noción de afecto en el derecho de familia: diálogo con la psicopatología y el psicoanálisis

O artigo procura discutir a proposição de que o afeto seja um dos principais determinantes de reconhecimento das relações familiares contemporâneas no direito, campo discursivo que legitima oficialmente a família. Para isso, realizou-se uma pesquisa teórica na qual explora-se a noção de afeto na linguagem cotidiana, na qual ele equivale a emoções, sentimentos e paixões, para cotejá-la com as definições da semiologia em psicopatologia, que também apresenta dificuldade em conceituar a referida noção. Utiliza-se, então, a psicanálise como teoria para ampliar a discussão, entendendo-se o afeto como efeito no Eu e no corpo da relação com o Outro por meio do significante. Isso permite incluir na leitura das relações familiares o desejo e a demanda, o que pode se traduzir em uma consideração do afeto para além de sua dimensão imaginária e contribuir para o trabalho dos psicólogos que lidam na interface com o direito de família.

Resumos This paper discusses the assumption that affect is a key determinant in recognizing contemporary family relations in law, a discursive field that officially legitimizes the family. To do so, a theoretical research explores the notion of affect in everyday language, which equates it to emotions, feelings, and passions, comparing it with the definitions of psychopathological semiology, which also fails to conceptualize the aforementioned notion. Psychoanalysis is used, therefore, to broaden the discussion, understanding affect as an effect produced by relations with the Other in the Self and in the body through the signifier. This allows us to include desire and demand in the reading of family relations, and thus to consider affect beyond its imaginary dimension and contribute to the work of psychologists who deal with family law.

Cet article interroge l'hypothèse selon laquelle l'affect est un déterminant essentiel de la reconnaissance des relations familiales contemporaines en droit, un champ discursif qui légitime officiellement la famille. Pour ce faire, une recherche théorique explore la notion d'affect dans le langage courant, qui l'assimile aux émotions, aux sentiments et aux passions, en la comparant aux définitions de la sémiologie en psychopathologie, qui ne parvient pas non plus à conceptualiser ladite notion. La psychanalyse est donc utilisé pour élargir la discussion, en comprenant l'affect comme un effet produit par les relations avec l'Autre sur le Moi et le corps à travers le signifiant. Cela nous permet d'inclure le désir et la demande dans la lecture des relations familiales, et donc de considérer l'affect au-delà de sa dimension imaginaire et de contribuer au travaux des psychologues qui s'occupent du droit de la famille.

El artículo trata de discutir la proposición de que el afecto sea uno de los principales determinantes de reconocimiento de las relaciones familiares contemporá-neas en el derecho, campo discursivo que legitima oficialmente la familia. Para ello se llevó a cabo una investigación teórica en la que se explora la noción del término afecto en el lenguaje cotidiano, en el cual es sinónimo de emociones, sentimientos y pasiones, para cotejarla con las definiciones de la semiologia psicopatológica, rama que también encuentra dificultad en definir esta noción. Por eso, se recurre al psicoanálisis como teoría con el fin de ampliar la discusión, entendiendo el afecto como efecto en el Yo y en el cuerpo de la relación con el Otro por medio del significante. Esto permite incluir en la lectura de las relaciones familiares el deseo y la demanda, lo que puede traducirse en una evaluación del afecto más allá de su dimensión imaginaria y contribuir así al labor de los psicólogos que actúan en la interfaz del derecho de familia.

The pivotal role of tricuspid regurgitation in the failing systemic right ventricle: The "chicken and egg story".

Systemic right ventricle (SRV) is commonly encountered in patients with congenital heart disease. This nomenclature includes diseases with different anatomic features, adaptation and clinical phenotypes, and has a variable - but overall guarded - prognosis. Right ventricular fibromuscular architecture, shape, adaptation to overload conditions, rhythmic disorders and - most of all - tricuspid regurgitation (TR) contribute to the pathophysiology of SRV failure. The pivotal role of TR is complex as it is due to both the intrinsic abnormalities of the valve (specific to each phenotype) and the consequence of SRV dilation and failure. Medical therapy has not been equivocally proven to be effective for TR. Surgery (valve repair or replacement) has shown conflicting long-term results, mainly dependent on preoperative SRV function. Thus, other management options have been proposed to improve SRV function and valve competency, such as early anatomical correction, pulmonary banding, resynchronization therapy and valvular edge-to-edge percutaneous repair. The aim of this review is to discuss the mechanisms of TR and SRV failure, as well as the available therapeutic options.

[Professional activity and cancer]. / Activité professionnelle et cancer.

A cancer diagnosis and the ensuing treatment process are a very sensitive period in a person's life. Beyond the disease and the treatments that can be spread out over time, the repercussions on the professional life and the financial balance of the household often worry patients. They are looking for simple and reliable advice to help them better understand their social and professional rights, as well as their duties.

[The Basics of Decision-Making Capacity: The Top-10 Principles for the Clinical Practice]. / Das kleine Einmaleins der Urteilsfähigkeit: Die Top-10-Grundsätze für die klinische Praxis.

The Basics of Decision-Making Capacity: The Top-10 Principles for the Clinical Practice Abstract. Decision-making capacity (decisional competence) as the ability to act rationally is a prerequisite for self-determination and is presumed in adults. In case of justified doubts, a cursory exam and, if necessary, an in-depth evaluation should be carried out. In this article, the concept of decision-making capacity is presented for the clinical practice based on the ten most important legal, ethical, and clinical principles. The criteria for assessing decision-making capacity, the relativity of decision-making capacity in terms of time and subject matter, and a possibly fluctuating decision-making capacity are highlighted. It becomes clear that decision-making incapacity is an attribution based on ethical-normative considerations. It should be noted that the decision of a person with decision-making capacity doesn't necessarily have to be reasonable. Finally, the assessment tool U-Doc is presented to support evaluation.

Right ventricular ejection fraction with cardiac magnetic resonance using a wall motion score.

BACKGROUND: The volumetric method in cardiac magnetic resonance (CMR), the reference standard for right ventricular ejection fraction (RVEF), requires expertise because of the complex right ventricular geometry and anatomical landmarks. AIM: The aim of our retrospective study was to describe a new method to evaluate RVEF based on wall motion score index (WMSI) in CMR. METHODS: Visual assessment of wall motion was performed using an eight-segment model (normokinesia=1, hypokinesia=2, akinesia=3). Correlation between WMSI (WMS/8) and the reference volumetric RVEF was analysed. A regression equation was derived to convert the WMSI into RVEF. The accuracy of CMR WMSI-derived RVEF compared with CMR volumetric RVEF was evaluated using Bland-Altman analysis. RESULTS: In the 112 patients using the volumetric method, the mean RVEF was 48±14%. Fifty-nine patients had normal RV kinetics (WMSI=1), which corresponded to a volumetric RVEF of 56% (standard deviation 7%; range 43-76%). CMR WMSI showed a strong correlation with CMR volumetric RVEF (Spearman's Rho=-0.69). A regression equation was created: RVEF=80-22×WMSI. Overall, the WMSI-derived RVEF resulted in good agreement with the CMR volumetric RVEF (mean bias-3%, standard deviation±7.5%). In addition, using a WMSI cut-off of≥1.5 was highly accurate (92%) to predict a reference RVEF of˂45%, an important prognostic indicator in CMR. CONCLUSIONS: Our results suggest that using the WMS in CMR (eight-segment) to estimate RVEF is accurate, and correlates well with the volumetric method. A WMSI≥1.5 is optimal to categorize patients in the higher-risk subset of CMR RVEF˂45%.

Right heart catheterization in advanced systolic heart failure. What are the most useful haemodynamic parameters for risk stratification?

BACKGROUND: Previous studies have shown that pulmonary hypertension is a predictor of mortality in patients with systolic heart failure (SHF). Persistent pulmonary hypertension after a reactivity test is associated with a worse outcome after transplantation. Recent studies have shown the utility of different haemodynamic parameters. AIMS: To define best haemodynamic parameters for risk stratification in patients with advanced systolic heart failure. METHODS: We included 425 consecutive patients who underwent a right heart catheterization with an inotropic challenge if indicated. RESULTS: During a median (interquartile range) follow-up of 1.67 (0.49-4.49) years, there were 151 major cardiac events (126 cardiovascular deaths and 25 postoperative deaths after ventricular assist device implantation or heart transplantation). The most powerful independent predictors of major cardiac events were baseline right atrial pressure (RAP) (hazard ratio [HR]: 1.09, 95% confidence interval [CI]: 1.06-1.12; P<0.0001) and baseline pulmonary vascular resistance (PVR) (HR: 1.10; 95% CI: 1.03-1.17; P=0.002). After inotropic challenge, the only independent predictor was mean pulmonary arterial pressure (mPAP) (HR: 1.06; 95% CI: 1.03-1.09; P<0.0001). The combination of PVR (≤or>3 Wood units), RAP (30mmHg) was the best predictor of major events. CONCLUSION: We suggest using a simple algorithm based on baseline PVR, baseline RAP and mPAP after the inotropic challenge for the risk stratification of stable patients with advanced systolic heart failure.

Septal versus apical pacing sites in permanent right ventricular pacing: The multicentre prospective SEPTAL-PM study.

BACKGROUND: The optimal right ventricular pacing site for patients requiring pacemaker implantation for permanent atrioventricular block is a matter of debate. Long-term right ventricular apical pacing has been associated with left ventricular ejection fraction impairment and heart failure. Right ventricular septal pacing has been proposed as an alternative. AIM: The aim of this randomized prospective multicentre trial was to compare left ventricular remodelling and outcomes between right ventricular apical and septal pacing after mid-term follow-up. METHODS: Patients requiring pacemaker implantation for high-degree atrioventricular block were enrolled and randomized in a 1:1 fashion to receive a right ventricular apical or septal lead. RESULTS: A total of 141 patients were included, 69 in the septal group and 72 in the apical group. Both groups exhibited similar left ventricular ejection fractions after 18 months of follow-up (septal 57.1±11.9% vs. apical 57.4±13.4%), and left ventricular ejection fraction variation was similar in the two groups at the end of follow-up (septal -1.5±13.2% vs. apical 0.3±13.3%). Additionally, left ventricular volume, quality of life and 6-minute walk distance were similar in the two groups. However, patients in the septal group were more likely to be asymptomatic, with a significantly lower concentration of N-terminal prohormone of brain natriuretic peptide. Lastly, lead position did not impact 18-month survival. CONCLUSION: Pacing from the right ventricular apex does not have any detrimental effect on left ventricular systolic function compared with septal pacing over an 18-month period.