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.     

COVID-19 : quel rôle pour les comités d’éthique ?

Let us take advantage of this state of health crisis to promote within the committees a real ethics of the discussion on research practices.     

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.     

Confinement : construction d’une nouvelle représentation sociale chez les étudiants et les salariés

IntroductionThe lockdown caused by the COVID-19 pandemic was a brutal experience that had a lasting impact on people's daily lives.ObjectiveThe construction of the social representation of this event was monitored over one year in two sampling phases (March 2020 and March 2021).MethodThe evolution of social representation was carried out using the hierarchical verbal association method and a characterisation questionnaire.ResultsThe results obtained highlighted, on one hand, the emergence of a figurative core, which is transformed into a central core by the repetition and pressure of the lockdown episodes. On the other hand, the variability of the social representation of confinement according to social status, employees structure the social representation around isolation whereas students are focused on loneliness.ConclusionThe effects of lockdown are reflected in the social representation of confinement, showing an impact on mental health, particularly on students.     

Flexibilité catégorielle chez des enfants scolarisés en ULIS : les effets d’un étayage métacognitif

Categorization is an essential cognitive process, but it seems deficient in children with intellectual disability. This study aimed to assess the improvement of categorization performances in children with intellectual disability by a metacognitive training. The specificity of the metacognitive training was tested by assessing two types of training, one metacognitive and the other not. The performances of categorical flexibility, that is to say, flexible use of categorization in 34 children with intellectual disability schooled in a special school (ULIS) were first evaluated. An intervention (metacognitive training, or training without metacognitive orientation, or no training) was then proposed one week later, followed by a second evaluation of the categorical flexibility performances. Furthermore, two versions of the categorical flexibility task were proposed so allowing the comparison of the use of perceptive categorization (shape and color) and semantic categorization (taxonomic and thematic). The results show that when the categorization requested are perceptive children with intellectual disability achieve performances at the ceiling level, contrary to the case of semantic categorization. Only children having benefited from a metacognitive training significantly increased their performances in semantic categorical flexibility task. These results show the possibility of training the semantic categorical flexibility in children with intellectual disability and suggest a possibility of transferring learning.     

La dynamique identitaire de stagiaires immigrants : Stratégies d’acculturation et insertion dans un collectif de travail

The aim of this research was to explore reciprocal relations between acculturative strategies of immigrant trainees and their “strategies” of integration into a workgroup. The investigation of each participant’s identity dynamics served as a basis to this qualitative and exploratory study, using the IMIS (multistage social identity investigator), created by Zavalloni and Louis-Guérin (1984, 2007). In both the cases presented here, work environments echoed back to some of the main obstacles opposing to the social integration of immigrants. Therefore, part of the results revealed spontaneous emergence of adaptative strategies simultaneously linking to cultures and the profession.     

D’un restaurant traditionnel à la mise en œuvre d’un restaurant « libéré » : impacts sur les métiers et le collectif de travail

The restaurant sector questions through the tensions and difficulties it encounters in order to retain employees. In order to cope with this, some managers are mobilizing managerial innovation. This action research exposes the effects on the trades and the work group of a reorganization of a traditional restaurant into a “freedom-form” company. Based on co-construction between researchers, employees and owners, and the use of qualitative methods (interviews, observations), the research presents the levers for more innovation and “happiness at work”. The study shows that the predispositions of the company and the attachment of employees to it were the essential motivating engine for imagining a new work organization.     

Revue de la littérature sur les jeunes aidants : qui sont-ils et comment les aider ?

Young carers (YC) are children and teenagers who provide care, help or support to a relative who is ill or has a disability. This literature review aims at presenting an overview on YC. Previously published studies mainly focused on estimating YC prevalence, exploring the areas in which YC provide help, especially caring activities, as well as positive and negative consequences of the caregiving experience (social, academic, physical, and psychological consequences). Specific tools to evaluate YC have been developed for professionals and researchers. Finally, if many interventions have been proposed for YC, they have rarely been evaluated. The limits of these studies are discussed and research perspectives are suggested.     

L’évaluation du risque de récidive et l’intervention basée sur les données probantes : les conditions nécessaires à l’implantation de méthodes structurées d’évaluation et d’intervention efficaces

The results of different studies on the best practices of the prevention of recidivism are clear: it is possible to reduce the risk of recidivism of offenders through efficient intervention. Structured risk assessment combined with practices based on risk, need and responsivity principals may reduce the risk of recidivism by up to 30%. These programs, developed primarily in Canada, require adaptations to better suit a French context. The present article proposes to revise the main stages essential to the introduction of a new evaluation and intervention strategy based on evidence, namely, the exploration, the preparation of the establishment, the creation and implementation themselves, the sustainability approach and the introduction of evaluative research studies. The advantages of considering such an implementation strategy are discussed.     

Insertion des femmes dans un métier « masculin » : transfert d’acquis d’expériences et stratégies identitaires

Entering a male-dominated occupation is favorable to the study of identity strategies. Based on a research among thirty female bus drivers, this article aims to demonstrate that the transfer – in the professional sphere – of knowledge, abilities, attitudes and values acquired in other spheres and times of socialization, is an important component of such strategies. Referred to the model of an active and plural socialization (Baubion-Broye & Hajjar, 1998 ; Almudever & al, 1999) and to Dubar’s distinction (2000) of a biographical and a relational transaction, the content analysis of the female bus drivers interviews allowed : a) to emphasize the relevance of using transfer of experiences acquisitions as an indicator of biographical transaction; b) to establish the links between transfer processes and gender positioning (as an indicator of relational transaction); c) to define three types of identity strategies distinguished by their level of transfer activation.     

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.     

Programmes de formation aux habiletés parentales pour les parents d’enfant avec un TDA/H : considérations pratiques et implications cliniques

The pharmacological treatment advocated for children affected by attention-deficit/hyperactivity disorder (ADHD) has now demonstrated its efficiency. However, its limitations and the impact of ADHD on family well-being, linked with parenting practices, make it necessary to establish an alternative treatment. Numerous studies agree about the effectiveness of Behavioral Parent Training programs (BPT). The purpose of this review, based on the literature describing BPT, is to analyze the factors that could influence the outcome of such interventions. Thus, the parameters of BPT, the characteristics of parents and children, will be mentioned in order to produce recommendations for clinicians and researchers interested in BPT within the framework of ADHD.     

Comment favoriser l’anticipation positive d’un déménagement organisationnel chez des salariés ? Test d’un modèle psychosocio-environnemental

French academic research on organizational relocation is scarce. This study aimed to explore how positive attitudes can be developed before organizational relocation using a psycho-social environmental model. More specifically, this paper analyzes the impact of workplace attachment and socio-professional support on anticipated satisfaction with relocation and the mediating role of the agreement with the top management decision to move. We conducted an empirical study with a sample of 119 employees of an audiovisual company based in France. Results show that anticipated satisfaction with relocation was inhibited by workplace attachment and facilitated by socio-professional support. Moreover, agreement with the change decision to move mediated these relationships.     

Coping et odontologie pédiatrique : construction d’un questionnaire français

ObjectiveThe purpose of this study was to build a tool of evaluation of the strategies the children use during a dental care.MethodThirty children (from six to 15 years old), 15 parents and 10 dentists participated in semidirective conversations and in observations.ResultsAn analysis of thematic contents of the conversations and the observations allowed to kick away five categories of strategies and to classify them according to the moment of the meeting.Conclusion and perspectivesQuestionnaires (behaviour, relation, cognition, emotion and somatic) were built. Once validated, these tools should allow to assess the strategies used by the child during a dental care.     

Conflit d’intérêts et déontologies : l’échec des déontologies existantes et l’improbable (?) succès de la loi

The increasing frequency with which health scandals have come to light since the 1980s has uncovered a great deal of unlawful behavior, both in the pharmaceutical industry and the medical profession, as well as in the world of “experts” (or researchers), along with journalists and specialist media companies. These types of behavior have accumulated and combined to inhibit any reaction from government, thus preventing health policy from playing its role. The State has its share of responsibility in this failure, for having been unable to conserve the impartiality and effectiveness of its administrative actions: it must acknowledge this, which is a whole other problem. However, in the case in point, it is obvious that those texts which must have been breached to allow these health scandals to occur are almost exclusively the result of professional self-regulation, with a wide range of diverse legal values: ethics for the health professions, journalistic ethics, charters between the pharmaceutical industry and media companies, alongside scientific ethical charters. These texts are the result of regulations generated by the professions themselves, drafted to counteract conflicts of interest. The sheer number of cases highlights the failure of these self-regulatory measures, leading to legislation targeting the problem, in particular that of December 29, 2011, which strengthened monitoring in terms of conflicts of interest and penalties against those placing themselves in a conflict of interest situation. Will this legislation, in direct response to the so-called Mediator^® case, be able to succeed where self-regulation failed, swept away as it was by financial considerations? The arbitrations that characterized the drafting of this legislation and the resulting complexity, which affects the decrees, seem to promise many difficulties, particularly due to the scarcity of resources the authorities have to enforce it.