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.     

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.     

Les publications des experts médicaux : l’exemple de l’anesthésie-réanimation

Forensic expertise becomes dominant in our society. Several reports questioned the competence of medical experts. We analysed the scientific competence of the 136 experts in Anaesthesia, Intensive Care and Emergency Medicine from senior courts in France. For that purpose, we made the choice of the H-Index and the number of scientific publications as markers of quality, using Google Scholar and PubMed databases. Thirty-five percent of experts have an H-Index equal to zero and 27 % never published. Out of the 104 experts who published at least one scientific article, 27 (26 %) did not publish for at least 10 years. The present study illustrates the great heterogeneity of the medical expert population regarding our criterions of judgement. This questions the selection and the operating mode of legal experts. There is a major difference with the selection process performed by the French Conciliation and Compensation Commissions. We propose that the official scholarly societies should be consulted during the appointment process.     

L’évaluation thérapeutique et collaborative : preuves empiriques

This paper covers the empirical research that addressed utility and effectiveness of therapeutic assessment or of its components (i.e., providing individualize feedback to clients). Studies vary in terms of methods and problems addressed but provide the consistent picture of therapeutic assessment as a brief approach which increases process variables related to subsequent treatment and has direct effects of symptoms reduction for a variety of psychological problems. Future directions of studies in this are finally provided.     

L’enfant réfugié en consultation : quelques considérations cliniques sur l’évaluation interculturelle

This article provides some cues to develop intercultural competency in clinical practice with migrant children and their families. Specific difficulties of refugee children in terms of psychopathology, school achievement and acculturation process are pointed out. A clinical vignette concerning a psychological assessment of an 11-year-old girl is presented to illustrate critical points. Some strategies to improve clinician's ability to provide services to people from diverse cultural backgrounds are discussed.     

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.     

Évaluer l’évolution psychologique des travailleurs d’Ésat : questions méthodologiques

ObjectiveTo point at and to discuss of some methodological problems in studies about psychological evolution of schizophrenic workers in ESAT (protected work).MethodFirst, the presentation of an empirical study (N: 25 schizophrenics) on this question, presentation of her results (no significant correlation between duration of work in ESAT and the assessed psychological dimensions (self esteem, depression, satisfaction with life, psychosocial skills); secondly, to point her methodological limits (epistemological, choice of instruments, comprehension of the specificity of the clinical situation). In conclusion some methodological propositions are indicated for a best apprehension of this complex situation (psychological evolution of these schizophrenic workers).     

L’expertise médicale au temps des pandémies : l’exemple des cancers

Medical law suits were interrupted during the COVID-19 pandemia and judicial process will come shortly back to the normal. Pandemia induced delays in the cancer diagnosis and treatment. These modifications were validated by expert consensus from the medical societies. However in the coming years it is highly possible that patients think they were victims of a “loss of chance” and ask for a compensation. The various situations in which physicians can be involved are described and recommendations for the management of medical charts are discussed.     

L’outil « estimateur », la ligne numérique mentale et les habiletés arithmétiques

This report presents the effects of learning study based on the Estimator program to learn the addition and subtraction operations on children selected for mathematical difficulties. The Estimator is designed to link the magnitudes of the mental number line with the verbal representations of exact arithmetic. Experiment shows that using the Estimator for five 30-minute sessions increases not only the children's arithmetic capacities but also other numerical knowledge assessed with Zareki-R. By taking account of the limits of the sample, the results are discussed in terms of (re) educational implications.     

Quand les technologies s’incarnent dans l’activité : le cas des réseaux sociaux numériques d’entreprise

Our aim to identify factors which support use or provide rejection for “regular” but non intensive Enterprise Social Network (ESN) users. From UTAUT model, we propose to adapt social context evaluation by fixing attention on professional stake and context. Our results show partial benefits for the tool in professional activity. Even if these results are able to explain user disaffection, it also questions ESN as the structuring artefact.     

Le LECPC version 1.1 : un logiciel d’étude de la compréhension du langage non littéral chez l’enfant

The purpose of this article is to present a new computerized system for studying nonliteral language comprehension in children: LECPC version 1.1, devoted more specifically to the understanding of indirect requests and idiomatic expressions. Nonliteral language exists when there is a difference between what a speaker says and the meaning he/she intends to transmit to the listener (e.g., saying “It's cold” to mean “Close the door”). In nonliteral language, the interaction context is crucial to understanding. LECPC version 1.1 is a methodological tool that can be used to incorporate the interaction situation into the study of language comprehension, in accordance with the requirements of experimental research. It is based on a story-completion paradigm, and looks and functions like a computer game. The system is well-suited to very young children, and is also applicable to a wide range of ages.     

L’évaluation thérapeutique : description de quatre modèles

Since its development, therapeutic assessment (TA) has been used in many different settings and adapted accordingly. There are four different TA models: adult, couple, child and adolescent. This article presents the steps of each model and addresses the specific similarities and differences between them.     

L’évaluation psychologique en situation transculturelle : une révision de la littérature

Human migration provokes transcultural clinical encounters that may challenge the way clinicians see themselves and how they proceed in their usual practices. In the field of psychology, psychological assessment is an important tool to better understand the patients’ needs and to design psychological interventions. Considering that most diagnostic tests and manuals have been developed in the Western context, the application of these tools with other populations remains controversial. The present literature review aims to describe the state of current knowledge on psychological transcultural assessment. Specifically, we will address: (1) the use of psychological tests in transcultural contexts, (2) the development of the Cultural Formulation Interview (CFI, DSM-5) and (3) the clinical interview: language, therapeutic relationship and participation of interpreters. In the first section, we discuss the international norms for scales and tests translation and adaptation, as well as the cultural issues that may bias the test’ application and interpretation. In the second section, we describe the creation of the CFI, and its use in recent studies. The CFI is composed by four clusters: (1) cultural definition of a problem, (2) cultural perceptions of cause, context, and support, (3) cultural factors affecting self-coping and past help seeking, and (4) cultural factors affecting current help seeking. The revised studies indicated that the CFI has a positive impact on the cultural sensibilization of mental health professionals, also improving the relationship between the patients and professionals. The cultural formulation may also prevent misdiagnosis. Beyond the use of tests and structured interviews, the clinician also faces other challenges during a transcultural assessment. We discuss in the third section the transferential and countertransferential relationship in a transcultural situation. Several elements may influence this relationship, at an individual, institutional and societal level. The evaluation of these elements may allow the clinician to better understand results of the psychological assessment. We also describe the current guidelines for the use of interpreters during health consultations in France. In conclusion, several advances have been made in the field of transcultural psychological assessment, among other things the development of guides for good translation and cultural adaptation of tools, as well as the integration of cultural issues into the DSM. However, research and changes in clinical practice are still needed, as the evaluation of cultural biases in cognitive tests and the expansion of cultural competences training among clinicians.     

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.     

Quelques réflexions sur l'évaluation de l'intelligence générale : un retour à Binet ?

At this centennial of the Binet-Simon test (1905), the edition of the WISC-IV (Wechsler, 2005) raises some questions about general intelligence. After outlining the different approaches of its evaluation, especially global versus factorial approaches, and its evolution, the objective is to show how that contributes to understand the changes presented in the WISC-IV. The scale is built on four factorial homogeneous indices corresponding to dimensions which are the most studied today: fluid intelligence, crystallized intelligence, working memory and fast processing abilities. Nevertheless, this multidimensionality is accompanied by certain redundancies and the reduction of some aspects, especially knowledge, visual-spatial intelligence and social intelligence. In conclusion, some fundamental principles are noted, which were defined by Binet, yielding a “flash-back to the source”.     

Le bilan de compétences : effets sur l’état émotionnel des bénéficiaires

Bilan de compétences (BC)’ effects on workers’ emotional states remain little explored. BC may reduce work-related negative emotional states and enhance positive ones. This was tested using a two-study design. In the first study, 38 respondents filled in the POMS-f, a questionnaire on emotional states, at the beginning or/and at the end of their BC. Six of them were also interviewed one week after the end of their BC. In the second study, 59 respondents filled in the same questionnaire at the beginning and at the end of their BC. In both studies, BC significantly reduced most of negative emotional states and increased positive ones.     

Qualités psychométriques d’une version francophone du « Displaced Aggression Questionnaire »

IntroductionThe Displaced Aggression Questionnaire is currently the only self-report instrument to measure individual tendency to displace aggression. It is composed of three factors, which assess an affective dimension (angry rumination), a cognitive dimension (revenge planning) and a behavioral dimension (displaced aggression).ObjectiveTo adapt a French translated version of the Displaced Aggression Questionnaire and test the psychometrics.MethodIn this study, we recruited 191 adults in the community. The questionnaire has been adapted and validated with respects to guidelines for the process of transcultural adaptation and validation of self-report measures. A principal component analysis has been used to assess the structure of the French version of the questionnaire.ResultsAfter taking into account one item that has not loaded onto any of the three expected factors, the principal component analysis confirmed the hypothesized three-factor structure for the French version of the questionnaire according to the original structure of the scale. It has been named Questionnaire d’Agression Déplacée in French. Results showed good psychometric qualities for the internal consistency, the discriminant and concomitant validity and the reliability.ConclusionBased on these positive results, this version can already be used by French speaking researchers.     

Utilisation d'une analyse de discours dans l'étude d'un cas de dédoublement de personnalité

The object of this article is to study the contribution of a discourse analysis software in comprehension of a case of dissociate personality disorder. Results obtained inform about the psychopathology of this case and give certain elements useful for the diagnostic discussion.