L’expertise médicale fondée sur les faits

The concept of evidence-based medicine applies to medical activity in general in order to rationalize it. The medical expertise, constantly looking to improve its quality, can no longer ignore this concept. This is the best tool to meet the mission entrusted to experts of assessing the conformity of care to the scientific-acquired features, without neglecting the assessment of the involved practitioner's skills and the particular circumstances of the plaintiff. This article develops the new concept of “Medical expertise based on facts”.     

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’expertise en ingénierie biomédicale ou du bon usage des dispositifs médicaux

How to limit the risks in the use of medical devices increasingly present in medicine an increasingly technologically complex? Simple and regulatory rules apply such as the CE marking. This becomes more complex when it is necessary to prove the compatibility of an assembly of several medical devices. The Vigilance on Medical Devices allows to alert after placing on the market when there has been an incident or a risk of incident on a failing medical device. Users training is one of the key point to control risks. Risk Training in specific fields such as the Electricity hazards associated with the use of electrical scalpels, laser-related hazards, electromagnetic fields, … is not sufficiently developed and renewed for good risk control. Finally, maintenance is a regulatory obligation and must be arranged for proper use of medical devices.     

L’expertise en responsabilité hospitalière dans le secteur public : l’exemple de l’AP–HP

Public hospitals in France are submitted to special rules different from those in private hospitals. Missions of judicial experts are quite similar but some differences may be found during expertal meetings.     

L’élargissement de l’assistance médicale à la procréation (AMP)

The opening of medically assisted procreation (MPA) for single women and couples of women, that is, apart from medical indications of infertility, raises the main question of the eradication of the father and of the paternal branch of the child's descent, which is difficult to reconcile with respect for the rights of the child, who has the right to know and be cared for his parents, as far as possible (International Convention on Human Rights of the child, Article 7 – 1). Moreover, the MPA claim for women appears to be an opportunity to lift the therapeutic lock to generalize access to artificial procreation, including fertile male/female couples, the most numerous being the target the most lucrative in the procreation market contained to date by the therapeutic objective assigned by the law to the MPA.     

La réception juridique de l’incertitude médicale

As regards medical responsibility, the proof of an unquestionable causal link between the damage and the fault of the expert are made difficult in the presence of uncertainties related to the etiology of certain pathologies. The article raises the question of the reception of this uncertainty by the judge and the legislator, and wonders in particular about the founded good of the recourse to law and judicial presumptions within the framework of the dispute of the victims of multiple sclerosis developed following vaccination against hepatitis B.     

L’effet médiateur de l’épuisement professionnel et des violences psychologiques dans le processus d’auto-objectification au travail

This study aims to highlight the mediating role of burnout and psychological violence between objectification and its consequences on the perception of oneself as an object. In total, 180 professionals responded to an online questionnaire to measure these constructs. The results reveal a direct effect of objectification on self-objectification, this effect being mediated by both burnout and the level of psychological violence. This study invites to question dehumanizing relationships at work and their conditions of emergence as a framework for interpreting risks at the workplace.     

Quelles méthodes et quelle modélisation d’analyse de l’activité de travail de l’encadrement ? L’exemple de l’encadrement des chantiers de la construction

By referring to the ergonomic analysis of work and to the management sciences, the authors propose an analysis model of the managers’ activity. Until then, few researchs were realized in ergonomics science with this population which has to prepare and to organize the works of other operators. According to the authors, it is possible to apply to this population the model of “the centre de décision”. It allows to understand how their activity is determined by “upstream” centres and then how it determines the activity of centres “approval”. Applied to the project and site managers, this model brings solutions to transform their work and the work of the workmen.     

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’affectivité positive et négative : des facteurs de protection ou de vulnérabilité à l’engagement au travail

This study examines the effects of work engagement on altruistic performance and emotional exhaustion as well as the moderating effect of the positive and negative affectivity traits. Data were collected through questionnaires among a sample of 279 employees working in a variety of industries. Results indicate that positive and negative affectivity exert distinct moderating influences on the effects of the dimensions of work engagement. Positive affectivity accentuates the positive effect of physical engagement on altruistic performance and the negative effect of emotional engagement on exhaustion. Negative affectivity acts as a moderator in the relationship between emotional engagement and exhaustion such that emotional engagement considerably reduces the risk of exhaustion among individuals with high levels of negative affectivity.     

Le développement contemporain des régimes juridiques des conflits d’intérêts : l’exemple du secteur de la santé

The conceptualization of conflicts of interests and deployment of their regulatory systems are primarily modes of economic and managerial health control. When did the legal regime of conflicts of interests, which formalizes the process, clash with the conditions of professional practice? Not all assumptions of friction or opposition of interests necessarily constitute a conflict of interests. All public sector professionals have interests but not all their interests generate conflicts. The aim of public declaration of interests is to reveal the relations of interest in order to allay suspicion. Most frequently in the form of soft law system, the declaration of interests is a way of warning about the existence of a “grey zone” or time of deontological risk. It was changed by the law of 29 December 2011     

La relation entre l’usage professionnel des technologies numériques et l’addiction au travail médiatisée par les demandes psychologiques au travail : quelles différences entre les hommes et les femmes ?

Considered as an additional job demand, the use of technologies for work-related reasons could increase psychological demands at work, favoring the appearance of workaholism. Our study examines the impact of the frequency of this use on psychological demands at work and workaholism in a sample of 223 people at work from various professional backgrounds, by verifying whether there are differences between men and women. The results showed that the use of technologies (desktop computer, laptop, tablet, smartphone/mobile phone) for work-related reasons increases psychological demands felt at work, consequently favoring the appearance of the two components of workaholism (working excessively and working compulsively) in men and women. In addition, the results show us gender differences: the strength of the relationship between the use of technologies for work-related reasons and working excessively, partially mediated by psychological demands at work, was slightly higher among men than in women; strength of the relationship between the use of technologies for work-related reasons and working compulsively, partially mediated by psychological demands at work, was found just among men, whereas a full mediation was found among women. This research highlights the importance of investigating the mechanisms that may explain how the use of technologies for work-related reasons could enhance the risk of work addiction, by considering gender differences.     

Cohésion–non-cohésion des scores composites : valeurs seuils et interprétabilité. L’exemple du WISC-IV

When interpreting the composite scores of the Wechsler Intelligence scales, some authors recommended to determine whether the composite scores are unitary or not. It has been suggested that when variability among scores is too large, then the composite score does not provide a good estimate of the psychological attribute, and is not interpretable. The first objective of the paper is to demonstrate that the cut-off threshold values (23 points and 5 points) proposed by some authors are inadequate. Other cut-off threshold values should be used. Most importantly, the second goal of this paper is to demonstrate that the notion of unitary abilities that was guiding principle of interpretation is also inadequate. Indeed, nonunitary index still provides relevant information.     

L’insertion professionnelle des enseignants débutants au Québec

With an aim of checking if educational circles took into account the professional induction of their beginning teachers, in the context of the renewed teacher educational formation, we investigated the working experience of newly graduated high-school teachers from University of Montreal in the years 1998-1999-2000. This study also tries to see if the renewed teacher educational formation inaugurated in 1994 plays a facilitating role in the beginning high school teachers’ induction and if professional exhaustion is part of their problems. The results obtained indicate that 94 % (N=165 out of 176) of the beginners participating in our study considered to have succeeded in their professional insertion. Most of them find their initial formation adequate. They say to be especially satisfied of the quantity and quality of the training courses and state that their formation covers well the various aspects of the actual teacher’s task. Beginners also find that school Commissions should greatly improve their facilitating measures of professional insertion. The results of the investigation showed that the professional insertion of the beginners is more difficult in the absence of helping measures. Finally, although the majority of beginners complain about the heaviness of their task, the investigation reveals that professional exhaustion does not play a part in the success or failure of their induction.