Les autorisations d’équipements lourds d’imagerie médicale : un désordre organisé

Medical imaging is essential for all medical specialties and it is natural that the government wants to create a real healthcare provision policy in this area. Medical imaging and particularly the “heavy” equipment are subject to a regulatory and legal framework. This framework results in respect of administrative authorization mechanism. These authorizations are a major tool for development of medical imaging on French territory. This mechanism is an important instrument of economic regulation in controlling health costs. However, the access to this kind of equipment raises various issues in governance and administration but also in matter of economic regulation, distribution of healthcare supply in medical imaging in health territories and respect of public health issues. The authorization mechanism raises questionings, not only at national and regional level in terms of unequal access, but also at European and international level. Indeed, France is among the last countries in the ranking of CT (computed tomography) and MRI (magnetic resonance imaging) equipment rates in comparison with many OECD (Organization for Economic Cooperation and Development) countries. Now, these authorizations will integrate much more the concepts of accessibility and quality of patient care. The legal and regulatory framework of these authorizations will have to evolve and to adapt to new technologies and practices, which today should be a source of significant cost savings.     

Face à la désorganisation somatique,animer la psyché

The author's purpose is to reflect about the function of the psychologist taking care of teenagers affected by somatic diseases, following the example of a therapy of a sixteen years old patient born with physical malformations and sexual ambiguity, suddenly suffering of severe somatic troubles, among them an insulin-dependent diabetes. The therapist may play a maternal function, as suggested by P. Marty. The idea is to give to the patient an alive, anaclitic and counter-exciting presence and a boundary context in order to make up for narcissistic deficiencies and to reach authentic movements. This article relates the way between the psychosomatic disorder and the new balance gradually reached. Trust and affective security are the preliminary conditions of autonomy.     

Les décisions d’orientation dépendent-elles des stéréotypes sociaux ? Sous quelles conditions ?

IntroductionIn this research we want to show that influence of social stereotypes linked to the social background on the students’ orientation is not a social fate that cannot be ignored but that there really are conditions that allow to reduce or even suppress those effects. The objective is to test the hypothesis according to which the seniority of the teachers, their type of professional commitment and the fact of working or not in an area earmarked for special educational assistance (prioritary education zone) must allow to significantly reduce the stereotypes effects on the academic judgment.MethodWithin the framework of an experimental research lead in school, we have asked high school teachers to express propositions of continuing studies as well as success predictions from ficticious student files reaching the end of high school. The results confirm that the bias generally observed in academic judgments are reduced in professors having a seniority above 5 years compared to the ones having a seniority lower than 5 years, those who have a strong work commitment, like the “self made persons” or “social activists” types, compared to those having a lower type of work commitment like the “self investors” or “careerists” types and those working in an area earmarked for special educational assistance (prioritary education zone) compared to those who work outside these areas.ConclusionThis research shows that factors likely to limit the effects of social background stereotypes on academic judgments do exist.     

Un cadre psychosocial d’intervention pour accompagner le développement et le déploiement d’une technologie nouvelle

This article presents a psychosocial intervention framework to support the development and deployment of a new technology. This methodology articulates the three phases necessary for the study of the representation of the use and its evolutions (i.e., the usual trajectory): acceptability, acceptance and appropriation. After an argumentative presentation of the methodological choices made, the article continues with the presentation of an example of accompaniment carried out within the framework of the IDViandes project aimed at the development of a traceability device for meat containers Of slaughter within the company SVA Jean-Rozé, subsidiary of the Intermarché group. This example argues in favor of the idea that the use of such a method makes it possible to optimize the successful accompaniment of the development of a technology and thus ensure its future diffusion.     

Méthode d’évaluation des risques psychosociaux auprès de travailleurs déficients intellectuels

While current regulation imposes to take into account psychosocial risks, their evaluation among workers with intellectual disabilities is still lacking. In order to develop an adapted tool, a language skills test was combined with the perception of work situations. Then, an ergonomic analysis was used to confirm the answers to the questionnaire. In a second phase of the study, the questionnaire was tested among a sample of 85 workers with intellectual disabilities. Data collected attested the relevance of this tool by accurately revealing workers’ feelings about their working environment. This study constitutes a first step in the psychosocial risk assessment process for workers with intellectual disabilities.     

Inhomogénéité des évaluations de durée d’incapacité totale de travail. Comparaison d’évaluations des durées d’incapacité totale de travail entre les médecins légistes,les médecins généralistes et les urgentistes

Setting a total length for time off work is a forensic act that all physicians must be able to perform. Given the importance of the legal consequences of this evaluation, it seems desirable that this practice is mastered by all practitioners. However, in practice there is often a disparity between forensic assessments and evaluations provided by other practitioners. To assess this difference in evaluation, we conducted a retrospective study, looking at 4 years of archives, of victims of Marseille's forensic service (CHU Timone), and highlighted a disparity between medical examiners, GPs and emergency physician's assessments. In both comparisons between medical examiners versus GPs (n = 367) or medical examiners versus emergency physicians (n = 511), were found in one third of cases of forensic requalification. The majority of checks on where GP's (80%) determined on over 8 days leave were reassessed under this limit by a medical examiner. This trend is reversed for the majority of (61%) requalification cases of emergency assessments (assessment over eight days by medical examiners. This study, proving a fact long suspected, raises many questions about these disparities evaluation we have discussed.     

Embolie gazeuse cérébrale lors d’une séance d’hémodialyse : aspects médico-légaux : à propos d’une affaire judiciaire

Air embolism is a serious iatrogenic event, concerning many invasive medical therapies. It is a rare but life-threatening adverse event. We report a case of a cerebral air embolism occurring during a renal replacement therapy. We report the case of a court case analyzed in the Department of Legal Medicine of Farhat Hached University Hospital in Sousse, Tunisia, related to a cerebral gas embolism occurring during a session of renal replacement therapy. Then we discuss the medical liability of the medical team involved in this act. Through a draft organic law (law No. 41/2019 on patients’ rights and medical liability), Tunisian jurisprudence aims at resolving legal claims in the field of medical liability by providing more opportunities for an amicable solution and by guaranteeing an adequate and quick compensation of the damage suffered.     

« Contexte évaluatif,règles d’équité et d’égalité. Une approche stratégique de la justice distributive. »

This article must be considered within the framework of research on distributive justice in the organisational context (Adams, 1965; Deutsch, 1975; Colquitt and Jackson, 2002). The aim is to propose an analysis from a political point of view of the orientation towards equity and equality rules. We take as a starting point the model of political decision in the organisational context by Murphy and Cleveland (1995). The political approach postulates that one cannot pertinently give an account of the managers’ decision modes without locating them in their daily context of human relations management, and their management strategy. We will examine the links between the context of immediate management and the managers’ choices for equity or equality. The results of two studies will be presented. They tend to legitimate the relevance of this approach.     

Le dégoût dans le trouble obsessionnel compulsif,mécanismes, évaluation,implications pour des pistes thérapeutiques

IntroductionAlthough considered a basic emotion, disgust has received little attention from research from the psychology of emotions compared to other emotions such as fear or sadness.Literature findingsMany empirical and experimental data suggest, however, that disgust plays a determining role not only in our ability to adapt to our environment but also in the maintenance and development of certain psychopathological states such as obsessive-compulsive disorders. The purpose of this article is to review the literature on the construct of disgust, including its two basic dimensions of disgust and disgust. A first part will be dedicated to the acquisition of disgust in the framework of evaluative and Pavlovian learning, we will then describe in detail the assessment tools available in the literature allowing to evaluate the different dimensions, then we will address the continuum. Experience of disgust, from normal disgust to pathological disgust, and will particularly target its role in dysfunctional obsessions of contamination and emotional distress.DiscussionIf, from a theoretical point of view, the understanding of the underlying mechanisms of pathological disgust reactions improves, the proposals for treatment to mitigate these reactions are rare. New approaches to care will be described to allow the development of empirically based psychological interventions.ConclusionThe recognition of emotional influences beyond anxiety in obsessive-compulsive disorder (OCD) stems from the fundamental importance of a dimensional approach to psychopathology and support. The accumulated data suggest that the inclusion of disgust in the theoretical models of OCD, in particular those with contamination concern, will thus improve our understanding and treatment of this disorder.     

Culture, migration et instrument de mesure: défis incontournables

The development of research instruments that are sensitive and appropriate to the realities of diverse ethnic communities is imperative in the current multiethnic context. The goal of this article is to discuss certain challenges encountered during the elaboration of a research instrument culturally-adapted to the South Asian culture. The instrument was designed in the context of a project that examines factors that influence health behaviours of and the use of preventive health services by, South Asian immigrant women living in Montreal. The different steps in the elaboration of the instrument, and the main challenges encountered are discussed. Recommendations are provided at the end of the article.     

Réflexions d’un médecin expert et d’un juriste autour d’un exercice pratique de droit médical

We offer a reflection around a clinical case of nosocomial infection allowing us to address the difficulties faced by experts and lawyers and other jurists in matters of medical liability. This case is the result of an exercise proposed within the framework of the national DIU (interuniversity diploma) in medical accidents for which the two authors are responsible in Amiens and Bordeaux. The writing was enriched with the responses of the students. This clinical case makes it possible to approach the compensation for nosocomial infections, to compare the amicable procedure before the conciliation and compensation commission for medical accidents and the procedure before a judicial or administrative jurisdiction. Finally, the reflection focuses on patient information, especially protected adult, and access to the medical file. It is not a question here of detailing the medical care but of discussing medical responsibility and the rights of the patients.     

La cross-évaluation : une approche d’évaluation et de développement des processus de travail inter-équipes

Organizational agility has become an increasing focus for companies and has led to the emergence of new developmental methods. This article presents the cross-evaluation as an approach to evaluating and developing inter-team interface efficacity. Though 360 degrees feedback collective processes are being evaluated, and during reflexive workshops they decide what improvements to make in their team functioning. Based on a literature review and more specifically on the theories of social identity and groupthink this article describes the scientific bases of the cross-evaluation method and the biases that can be involved and how to reduce them. It suggests new avenues of research and practical suggestions for practitioners about an inter-team development method.     

Évolutions récentes de la responsabilité pour défaut d’information

It is wrongly that one would think that the question of the information due by the physician to the patient is not likely of any further developments. Four recent rulings provide the perfect illustration and lead to consider that this duty to inform has attained a genuine autonomy. In some instances, the compensation arising out of the failure to inform may depart from the strict framework of loss of chance in which many believed it was confined to.     

Parcours : développement d’une stratégie de prévention de la récidive adaptée aux milieux ouverts

Experiments show that applying RNR principles “in the real world” within the context of probation can reduce recidivism, provided that evidence-based intervention models are used. In Quebec, probation officers agreed to take part in a pilot project whereby the Parcours program (Pathways) was transposed into a series of interview outlines to be used in a community setting. The experiment took place over a one-year period, the management of convicted offenders consisting in around 10 30 to 90-minute interviews. These interviews addressed: motivation for change, beliefs, values and cognitive distortions, as well as the adoption of relapse prevention strategies. Results were positive enough to authorize the deployment of Parcours en milieu ouvert (Pathways in community settings) in all sectors. This approach could be implemented in France, where at the instigation of the Council of Europe, new European probation rules recommend the establishment of interventions based on evidence-based models.     

Défaut d’information préalable : présomption de la souffrance morale et préjudice d’impréparation

The Conseil d’État, relatively to the ruling dated the 16th of June 2016, keeps defining the legal regime of the harm of unpreparedness which consists in a violation of the health professionals’ duty to inform their patients, based on article L. 1111-2 of Code de la santé publique. Moreover, it can be highlighted a shared understanding between the judicial and administrative jurisprudences. Yet, the Conseil d’État is likely withholding the patients’ right to information that the Cour de cassation may have headed toward.     

Critique,rhétoricité, communicabilité

La critique et la théorie littéraires contemporaines présentent un paradoxe: elles notent, par la référence à la rhétorique, la rupture de la propriété argumentative ou persuasive de l'oeuvre; elles préservent cependant l'hypothèse d'une propriété conversationnelle du littéraire — hypothèse qui n'est pas véritablement explicitée. Ce paradoxe, essentiellement lisible dans la déconstruction, l'est aussi dans les propositions de Sartre, dans la pensée du dehors de Foucault, dans le dialogisme de Bakhtine. Le paradoxe revient, de fait — telle est la thèse de cet article — à énoncer une propriété rhétorique et persuasive de l'oeuvre, au moyen d'une référence à la rhétorique d'abord confondue avec la tropologie et avec l'effacement du jeu persuasif. Cette ultime propriété rhétorique et persuasive est identifiable par l'alliance de lasuspension, qui caractérise le texte littéraire dès lors qu'il est placé sous le signe de la rupture de l'argument et de la persuasion, et du jeu anaphorique, lui-même indissociable du questionnement que suscite la suspension. A partir du constat de ce questionnement, il convient de dire que le texte littéraire est ce qui fait fond à la disparité du doxique, et que celui-ci apparaît comme le répondant provisiore et variable de lacasuistique que constitue le texte littéraire.     

Le développement d’un outil de mesure des comportements inadaptés au travail auprès de directions d’établissements scolaires du Québec

This study focuses on developing a measuring tool for unsuitable behaviour in the workplace. The tool has been developed from school principals. To do so, exploratory factor analyses have been conducted. Data have been collected from 232 senior staff members from school facilities across Quebec. Participants were invited to answer an online questionnaire. The results obtained help to classify inappropriate work behaviour into one factor. In addition to its theoretical value, this research brings several significant contributions to practice.     

Les effets de l’attrait,du sexe,des aptitudes de candidats à des postes de niveau hiérarchique et type sexuel différents sur les jugements de recrutabilité, d’utilité et de désirabilité

Gender or beauty stereotypes strongly influence evaluations and hiring decisions. Recent studies (Jawahar & Mattson, 2005) show an evolution of the lack of Fit model (Heilman, 1983) : the beauty of the women is not any more a handicap for certain managerial jobs. In order to test the model, we distinguished the hierarchical status and the sex type of the job and we measured the effects of attractiveness, gender and of the aptitude on the hirability, on the perceived desirability and utility and on the perceived competence. According to the variance analysis, the attractive applicants were ranked as more hirable, more useful, more socially desirable, and more competent. The applicants who were highly qualified were considered more hirable, more useful and more competent but the aptitude did not influence the desirability.