Placement hors du milieu familial et usage des médicaments psychotropes

North American epidemiological studies establish that 50% of young people in need of protection and child welfare have received mental health diagnoses. In the juvenile justice system, it seems that 50% to 60% of young offenders respond positively to some criteria for a mental disorder. The extent of use of services related to mental health by foster children or youth raised the question of psychotropic drugs use and compliance. If some authors and clinicians may assume that the nature of secured institutions, with what it involves in terms of monitoring and control, guarantees an excellent compliance. However, pilot studies we conducted show that this is not the case. To study adherence, the World Health Organization stated in 2003 that it implies some patient characteristics, but also clinical (eg: illness and treatment), family (eg: parental involvement) and contextual (eg: team care and health system) ones. The study of health behaviors has recently moved from a cognitive behavioral centered model on to a systemic/sociological one which incorporates interactions between the individual and his social environment. From an optimal use standpoint, adherence is studied as a contextualized set of behaviors and attitudes. Therefore, to understand compliance, it seems very important to understand the subjective theories of disease that will be developed by the youth and the working alliance he will establish with the pharmaco-prescriber.     

Placement Matching: Challenges and Technical Progress

Although it is highly desirable, standardized placement matching for substance use disorders poses challenges due to variability in settings, services, and syndromes; multidimensionality of clinical problems; multiplicity of outcome constructs; and temporal phenomena in the course of recovery. Despite these obstacles, progress is being made in developing patient placement criteria that are comprehensive with adequate reliability, feasibility, and resolution. With these methodological advances, it has been possible to initiate controlled research with placement criteria. The first such studies provide early evidence supporting such criteria and indicate areas for refinement.     

An augmented reality system characterization of placement accuracy in neurosurgery

Computer assisted navigation (CAN) is a technology which has been available for commercial use in operating rooms for quite some time now. CAN relies on the information presented in patient imaging (usually CT or MRI images) and the surgical site. The method for registration between these two sets of data is crucial for safe image guided navigation during surgery. Although the existing technologies are extremely accurate, they still pose problems in the operating. Motivation for this study is to explore the possibility of using augmented reality (AR) to improve ease of use for surgical navigation and provide a system which complements the existing operating room workflow. As with all commercially available surgical navigation systems, registration accuracy is of utmost important to maintain patient safety. In this paper, we propose a novel method to quantify registration accuracy for augmented reality (AR) devices in neurosurgery.     

How do the attitudes of therapeutic radiographers affect students’ learning during practice placement?

IntroductionPractice placements are essential for radiotherapy students to learn and embed the necessary skills for practice; thus, each placement should afford an optimum learning experience. A key finding from the Phase 3 student arm of recent doctoral research suggests that for some students an optimum learning experience is not guaranteed. Using students' own words, this paper seeks to increase radiographers' awareness of how their behaviours can affect students’ placement learning, and aims to help improve the placement learning experience for both.MethodA three-phase, U.K.-wide, mixed methods study was conducted. In the Phase 3 student arm, qualitative data were gathered via focus groups/interviews from volunteer student radiographers. Data were transcribed, manually coded, and analysed thematically by the Researcher using the applied research methodology Framework Analysis.ResultsThe analysed data were complimentary to radiographers, overall, but common themes were identified criticising certain of their attitudes and behaviours. Students exhibited fragility in response to perceived negative attitudes and behaviours, and failed to develop resilience in response to further similar experiences. This had a negative effect on their placement learning. Positive attitudes from radiographers enhanced students’ placement learning. The placement experiences of radiotherapy students are consistent with those of other AHP and nursing students identified in the literature.ConclusionIncreasing radiographers' awareness of the negative and positive effects of their behaviours and attitudes will help improve students' placement learning experience. Students’ resilience may be improved by teaching them coping strategies to use on placement.Implications for practiceThe retention of radiotherapy students is an urgent concern for the radiotherapy profession therefore it is important to take steps to improve it. Enhancing students’ placement experience may contribute to increased retention.     

Nursing and midwifery students' encounters with poor clinical practice: A systematic review

The aim of this paper was to systematically review evidence about nursing and midwifery students’ encounters with poor clinical care.We undertook a systematic review of English language empirical research using multiple databases from inception to April 2016. Hand searching was also undertaken. Included papers contained accounts of empirical research which reported on students’ encounters with poor care. These were quality-assessed, information was extracted into tables, and study results were synthesized using thematic analysis.N = 14 papers met inclusion criteria; study quality was moderate to good. Study synthesis revealed four themes: i) encounters with poor practice: students encounter poor practice that is likely to be worthy of professional sanction; ii) while intention to report is high in hypothetical scenarios, this appears not always to translate to actual practice; iii) a range of influencing factors impact the likelihood of reporting; iv) the consequences of encountering and subsequently reporting poor practice appeared to have a lasting effect on students.Research is required to determine the frequency and nature of students' encounters with poor care, when and where they encounter it, how to increase the likelihood that they will report it, and how they can be supported in doing so.     

腰硬联合麻醉留置尿管时机选择的研究

目的 探讨实施腰硬联合麻醉患者留置尿管的最佳时机.方法 选择300例行腰硬联合麻醉的患者,将其随机分A、B、C三组,分别有93、102、105例.A组在腰硬联合麻醉前留置尿管,B组在腰硬联合麻醉后5 min内留置尿管,C组为腰硬联合麻醉后5 min后留置尿管.所有患者分别在导尿前、导尿操作期间即刻记录血压、心率.在导尿后按疼痛程度评定标准评定三组患者在导尿操作过程中的疼痛程度.结果 与A、B两组患者相比,腰硬联合麻醉后5 min后留置尿管的C组患者在操作期间的收缩压(F=28.523,P=0.036)、舒张压(F=19.674,P=0.001)、心率(F=8.523,P=0.042)无明显变化,疼痛不适发生率最低(x2=16.415,P=0.025),且插管成功率最高(x2=11.631,P=0.042),差异有统计学意义.结论 手术患者腰硬联合麻醉后5 min后留置尿管时机最为适宜.     

Placements dans l’enfance et devenir à l’âge adulte : insertion générale et qualité de vie liée à la santé

Background

Child welfare literature underlines a higher prevalence of health problems and psychiatric disabilities in fostered young people than in the general population. Questions remain about their social integration and health in the long term: Which risk factors continue to alter their pathway? Which protective factors have minimized a problematic psychosocial adaptation over time?

Purpose

A follow-up study in the past was conducted on a SOS children's village on 123 young people who had been reared for more than 3 years and left care after the age of 14. A survey was mailed to these adults aged 23–50 years old, followed by face-to-face interviews. All relevant institutional files were analysed. Attrition rates were very low in this high-risk population. An overall score of social integration aggregates data regarding: occupational situation, family life, relationships, general psychosocial state. Health-related quality of life (Duke Profile) was analyzed by means of multiple dimensions including mental and social health, self-esteem, depression and disability. Multivariate analyses by logistic regression were used to examine the specific roles of decisive factors on social integration.

Key findings

At a mean age of 36.5 years, two thirds were well integrated socio-economically, only one out of five had psychosocial problems. Three factors increased the risk of poor socioeconomic integration: accumulation of parental risk factors, having been placed with two or more siblings’ groups and persisting mental health problems when leaving care. The quality of life was significantly associated with a better perception of social and mental health and with self-esteem. It varied positively, taken into account with professional integration, relationships and supportive environment, and negatively according to past adversities: parental domestic violence, maltreatment, and persisting mental health problems. Except from disabilities and to a lesser degree sociability, globally, these former fostered population did not seem different from counterparts in terms of health measures, anxiety and depression.

Implications

Results highlight the importance of continuity and stability in placement. For the professionals, it is necessary to give more attention to the question of rearing together several groups of siblings. Persisting mental health problems during placement and when leaving care would suggest a vital need for the staff to identify and to implement intensive, appropriate therapeutic care.     

新型直丝弓托槽定位器的开发研究

目的开发一种适合于直丝弓托槽的定位器,为其精确定位提供测量工具。方法定位器由3.0mm×6.0mm不锈钢制成,先将不锈钢弯成规定的形态,然后采用数控机床机械加工,以线切割方式,一次整体加工成形,经打磨、电化学抛光处理,使其表面光洁。定位器分为3部分:中间直柄部、远离牙弓的弯曲部及反向的测量弯头。定位器全长146mm,直柄部与弯曲部呈145°夹角,弯曲部分测量弯头为105°夹角,定位器弯头由牙合向置入端与槽沟置入端组成,牙合向置入端长10mm,厚2mm,槽沟置放端长2mm,厚0.4mm。定位器一套由8根组成,其测量范围在2.0～5.5mm之间,反映不同的牙合缘至槽沟中点的垂直距离。结果新型直丝弓托槽定位器可用于确定直丝弓托槽的垂直位置。结论新型直丝弓托槽定位器结合个体直丝托槽定位表,可明显提高托槽垂直置入的精度。