Gouvernance et éthique cliniques : deux outils complémentaires pour une meilleure coordination des soins et des traitements

“Governance”, “ethics” and “clinical” three words for a same goal: protect the human health. “Corporate governance” must be associated with the new theory of the firm, for which the theory of asymmetric information provides the foundations. Indeed problems of information represent a fundamental change in the prevailing paradigm within economics; they are central to understanding political economy. “Clinical governance”, promoted by the UK government, constitutes an overarching mechanism designed to improve clinical quality in the National Health Service. To the medical establishment, it is a means to improve the quality of medical practice through clinical guidelines. To make a significant impact on the improvement of healthcare quality, the principles of clinical governance must produce synergy by involving professionals in the modernization of the organization. To obtain excellence in heath care, collective actions and shared decision making were essential. In this context, Clinical ethics consultations could provide a structured approach to decision making that could assist heath professional to resolve conflicts or ethical problems that arise in the care of particular patients.     

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”.     

The space between us: stereotype threat and distance in interracial contexts

Four studies investigate the role that stereotype threat plays in producing racial distancing behavior in an anticipated conversation paradigm. It was hypothesized that the threat of appearing racist may have the ironic effect of causing Whites to distance themselves from Black conversation partners. In Study 1, participants distanced themselves more from Black partners under conditions of threat, and this distance correlated with the activation of a "White racist" stereotype. In Study 2, it was demonstrated that Whites' interracial distancing behavior was not predicted by explicit or implicit prejudice. Study 3 provides evidence that conceiving of interracial interactions as opportunities to learn may attenuate the negative consequences of threat for Whites. Study 4 found that Whites have conscious access to their experience of stereotype threat and that this awareness may mediate the relationship between threat and distance. These results are discussed within a broader discourse of racial distancing and the possibility that certain identity threats may be as important as prejudice in determining the outcomes of interracial interactions.     

Standing between two worlds in Harlem: A developmental psychopathology perspective of perinatally acquired human immunodeficiency virus and adolescence

Perinatal HIV infection in the US continues to evolve from a fatal pediatric illness to a chronic medical condition of childhood and adolescence. Although navigating this period is influenced by multi-leveled deprivations commonly experienced by low-income minority families, HIV alters the timing and experience of developmental milestones for many adolescents with perinatal HIV. This selective review of the growing developmental psychopathology literature and the authors' clinical work at a pediatric HIV program in Harlem, NY provide an overview of how developmental psychopathology offers an integrative framework that elucidates how autonomy, peer relationships, and self-concept evolve among 13–21 year old adolescents. This paper highlights the importance of considering influences of both perinatal HIV and the culture of poverty on adolescent development, and of adopting multilevel interventions and research to address how interactions among biologic, environmental, and HIV-related stressors (serostatus disclosure, medical treatment adherence, illness stigma) influence the development of adolescents with perinatal HIV.     

Adjusting to job demands: The role of work self-determination and job control in predicting burnout

This study examined the dynamic interplay among job demands, job control, and work self-determination in order to predict burnout dimensions. A three-way interaction effect was found between job demands, job control and work self-determination in predicting each dimension of burnout (emotional exhaustion, depersonalization, and personal accomplishment). Overall, results showed that job control moderates the unhealthy effects of job demands in predicting emotional exhaustion and depersonalization only for employees with high levels of work self-determination. In addition, job control increases the relation between job demands and the sense of personal accomplishment only for employees with high levels of work self-determination. These results are discussed in light of the Job Demand-Control model.     

Cattle discriminate between familiar and unfamiliar conspecifics by using only head visual cues

Faces have features characteristic of the identity, age and sex of an individual. In the context of social communication and social recognition in various animal species, facial information is relevant for discriminating between familiar and unfamiliar individuals. Here, we present two experiments aimed at testing the ability of cattle (Bos taurus) to visually discriminate between heads (including face views) of familiar and unfamiliar conspecifics represented as 2D images. In the first experiment, we observed the spontaneous behaviour of heifers when images of familiar and unfamiliar conspecifics were simultaneously presented. Our results show that heifers were more attracted towards the image of a familiar conspecific (i.e., it was chosen first, explored more, and given more attention) than towards the image of an unfamiliar one. In the second experiment, the ability to discriminate between images of familiar and unfamiliar conspecifics was tested using a food-rewarded instrumental conditioning procedure. Eight out of the nine heifers succeeded in discriminating between images of familiar and unfamiliar conspecifics and in generalizing on the first trial to a new pair of images of familiar and unfamiliar conspecifics, suggesting a categorization process of familiar versus unfamiliar conspecifics in cattle. Results of the first experiment and the observation of ear postures during the learning process, which was used as an index of the emotional state, provided information on picture processing in cattle and lead us to conclude that images of conspecifics were treated as representations of real individuals.     

Physicians' understanding of patients' personal representations of their diabetes: accuracy and association with self-care

The degree of accuracy with which physicians understand their patients' views may be of central importance for promoting self-care in the majority of chronic illnesses and in type 2 diabetes in particular. The objectives of this study were to measure the accuracy of the general practitioners' understanding of the patients' views and relate it to health behavioural outcomes in patients with non-complicated type 2 diabetes. The participants in this cross-sectional study consisted of 14 clinicians and 78 of their patients from Paris, France. The predictors were levels of accuracy in understanding the patients' views derived from the illness perception questionnaire-revised (IPQ-R). The outcomes were patient-reported self-care measures. In regression models controlling for clinical and personal variables, higher accuracy on chronicity beliefs was associated with an improved diet and increased blood glucose self-testing and higher accuracy in identifying treatment control beliefs was associated with better dietary self-care. Accuracy was higher with regard to beliefs about causes, treatment control and consequences. These results suggest that accuracy may impact self-care in specific domains of illness perception but not others. The results may help identify useful avenues of communication training designed for professionals.