Parcours de soins

Parcours de soins
  • 文章类型: English Abstract
    造血干细胞的同种异体移植仍然是某些血液系统恶性肿瘤的唯一治愈性治疗方法。这种治疗可能导致许多副作用,导致多重和相互依存的身体和心理缺陷,影响患者的生活质量和社会参与,可以作为一个障碍来体验,有时移植后几年。几年来,移植后康复途径的整合变得越来越普遍,正在研究在越来越早的阶段提供多学科护理的举措。这种早期管理的目的是改善患者的整体功能状态,在移植期间和之后,以限制治疗的影响,并确保尽可能快地回到尽可能令人满意的生活。在整个法语世界中进行的国际文献和实验描述了异质实践。基于这些文献和经验,这项研究的目的是为良好的临床实践发布同质的建议,并确定进一步研究移植前的领域,造血干细胞的每次移植和移植后康复。
    Allogeneic transplantation of haematopoietic stem cells is still the only curative treatment for certain haematological malignancies. This treatment can be responsible for a number of side-effects, leading to multiple and interdependent physical and psychological deficiencies that affect patients\' quality of life and social participation, and can be experienced as a handicap, sometimes for several years after the transplant. For several years now, the integration of post-transplant rehabilitation pathways has been becoming more widespread, and initiatives to provide multidisciplinary care at an increasingly early stage are being studied. The aim of this early management is to improve the patient\'s overall functional state before, during and after the transplant, in order to limit the impact of the treatment and ensure the quickest possible return to a life that is as satisfying as possible. The international literature and the experiments carried out throughout the French-speaking world describe heterogeneous practices. Based on this literature and experience, the aim of this study is to issue homogenous recommendations for good clinical practice and to identify areas for further research into pre-transplant, per-transplant and post-transplant rehabilitation of haematopoietic stem cells.
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  • 文章类型: English Abstract
    面对乳腺癌,处于不稳定状态的女性更有可能在晚期被诊断出来,当在同一阶段检测到时,他们死得更快,也更快。在本文中,我们分析了在巴黎地区的6家癌症服务机构中进行的关于乳腺癌女性护理途径的40次半结构化访谈。分析的重点是路径的开始(直到第一次治疗),并根据不稳定的情况集中在它们的空间和时间维度上。根据女性在不稳定方面的情况,路径的时空组织不同。有社会差异的潜伏期延迟诊断(在会见医疗专业人员之前)或开始治疗(关于权利,医疗保健系统的反应能力,以及女性与系统之间的互动)。空间上,路径的几何形状是可变的,并根据妇女的社会概况反映了医疗机构和医务人员的不同期望。然而,对路径的详细分析使我们能够在不稳定方面细微差别。妇女的自主能力,他们的联系网络,医疗保健系统的可及性和响应性,以及这种压力事件的敏感和情感维度在时间和空间上都会影响路径。
    Facing breast cancer, women in precarious situations are more likely to be diagnosed at an advanced stage, and when detected at the same stage, they are more to die as well as faster. In this paper, we analyze a corpus of 40 semi-structured interviews conducted in six cancer services in hospitals of the Paris area on the care pathways of women with breast cancer. The analysis focuses on the beginning of the pathways (until the first treatments) and concentrates on their spatial and temporal dimension in the light of precariousness. Depending on the women\'s situations with regard to precariousness, the spatial and temporal organization of the pathways differs. There are socially differentiated latency periods that delay diagnosis (prior to meeting a medical professional) or the beginning of treatment (in relation to rights, the responsiveness of the health care system, and the interactions between women and the system). Spatially, the geometry of the pathways is variable and reflects different expectations of health institutions and medical staff according to the social profiles of the women. However, a detailed analysis of the pathways allows us to nuance these differences in terms of precariousness. The women\'s capacity to be autonomous, their network of contacts, the accessibility and responsiveness of the health care system, as well as the sensitive and emotional dimension of this stressful event affect the pathways both in terms of time and space.
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  • 文章类型: English Abstract
    背景:“社区康复计划”(PRADO)COPD是一项家庭出院支持计划,致力于组织COPD加重住院后的护理途径。这项研究旨在评估其医学经济影响。
    方法:这是2017年至2019年PRADOBPCO患者的回顾性数据库研究。数据来自国家健康数据系统。使用倾向评分匹配建立对照组。在住院后的一年中测量了Morbi死亡率和费用(从国家健康保险的角度来看)。
    结果:虽然PRADO组中符合国家卫生局建议的护理途径的患者比例较高,对死亡率和12个月再住院无显著影响.在普拉多集团,当护理途径最佳时,再住院率较低.PRADO组每位患者的医疗费用高出670欧元。
    结论:PRADOCOPD改善了护理质量,但没有降低再住院率和死亡率,尽管受益于最佳治疗途径的PRADO组患者的再住院率确实有所下降.
    BACKGROUND: The \"Programme d\'Accompagnement du retour à Domicile\" (PRADO) COPD is a home discharge support program dedicated to organizing care pathways following hospitalization for COPD exacerbation. This study aimed at assessing its medico-economic impact.
    METHODS: This was a retrospective database study of patients included in the PRADO BPCO between 2017 and 2019. Data were extracted from the National Health Data System. A control group was built using propensity score matching. Morbi-mortality and costs (national health insurance perspective) were measured during the year following hospitalization.
    RESULTS: While the proportion of patients with a care pathway complying with recommendations from the National Health Authority was higher in the PRADO group, there was no significant effect on mortality and 12-month rehospitalization. In the PRADO group, the rehospitalization rate was lower when the care pathway was optimal. Healthcare costs per patient were 670 € higher in the PRADO group.
    CONCLUSIONS: The PRADO COPD improves quality of care but without decreasing rehospitalizations and mortality, although rehospitalizations did decrease among PRADO group patients benefiting from an optimal care pathway.
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  • 文章类型: Journal Article
    法国高级实践护理的作用仍处于定义阶段。虽然该模型的预测主要是在初级保健中,特别是通过Asalée协会的活动,第一批大学毕业生主要是未来的医院专业人士,有专门的方向。无论是从事普通医学还是器官医学,高级执业护士(APN)致力于使患者的护理体验更加流畅,作为一个多专业团队的一部分。由于获得了新技能和结构化的法律框架,医生和APN之间的合作正在成为一种蕾丝制作过程,最好地满足当地的需求。
    The role of advanced practice nursing in France is still in its definition phase. While the prefiguration of the model was mainly in primary care, notably through the activities of the Asalée association, the first university graduates are mainly future hospital professionals, with a specialized orientation. Whether working in general or organ medicine, the advanced practice nurse (APN) is committed to making the patient\'s care experience more fluid, as part of a multi-professional team. Thanks to the acquisition of new skills and a structuring legal framework, collaboration between doctors and APNs is becoming a lace-making process, to best meet local needs.
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  • 文章类型: Journal Article
    护士在法国的医疗体系中是无所不知的。它们是医疗保健系统中必不可少的环节,它们的附加值是毋庸置疑的。该行业需要进行改革,以跟上护理实践和人口需求的当前发展。
    Nurses are omniscient in the French healthcare system. They are an essential link in the healthcare system, and their added value is unquestionable. The profession needs to be revamped to keep pace with current developments in nursing practices and the needs of the population.
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  • 文章类型: English Abstract
    慢性心力衰竭的发病率在西方国家持续上升,证明实施基于医疗和护理融合的优化多学科组织的合理性。围绕主要的心力衰竭,图卢兹大学医院的援助和移植部门,为了更好地管理心力衰竭患者和改善他们的护理途径,已经建立了几个结构.
    The incidence of chronic heart failure continues to rise in Western countries, justifying the implementation of an optimized multidisciplinary organization based on medical and nursing convergence. Around the main heart failure, assistance and transplantation unit at Toulouse University Hospital, several structures have been put in place to better manage heart failure patients and improve their care pathway.
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  • 文章类型: English Abstract
    护士协调员在医疗保健网络中工作,以确保向患者提供的护理的连续性和质量。它们充当医疗之间的接口,辅助医疗和社会护理。在一些部门,他们协调外科康复和强化康复计划,旨在优化身体,大手术前每位患者的营养和心理状态。知道如何指导患者和他们的家人,建议他们并重新解释出院的医疗处方,以了解他们的情况并向他们保证,同时使他们能够计划出院。
    The nurse coordinator works within a healthcare network to ensure the continuity and quality of the care provided to patients. They act as the interface between medical, paramedical and social care. In some departments, they coordinate the surgical prehabilitation and enhanced rehabilitation program, which aims to optimize the physical, nutritional and psychological state of each patient prior to major surgery. Knowing how to guide patients and their families, advise them and re-explain the medical prescription for discharge sheds light on their situation and reassures them, while enabling them to plan their discharge.
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  • 文章类型: English Abstract
    手术后增强康复(ERAS)是涉及手术护理途径的新组织的范例。其主要目标是最大限度地提高接受手术的人的康复。这是一种基于证据数据和高层建议的多模式方法,结合使用临床指标对患者手术路径质量的日常评估,这些临床指标约为20条建议。这种实施需要所有参与护理过程的专业人员的参与。ERAS护士协调员就是其中之一。
    Enhanced Rehabilitation after Surgery (ERAS) is a paradigm involving a new organization of surgical care pathways. Its main objective is to maximize the rehabilitation of people undergoing surgery. It is a multimodal approach based on evidence-based data and high-level recommendations, combined with daily assessment of the quality of the patient\'s surgical pathway using clinical indicators grouped around some twenty recommendations. This implementation requires the involvement of all professionals involved in the care process. The ERAS nurse coordinator is one of them.
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  • 文章类型: English Abstract
    帕金森专家中心(PEC)的建立导致了新护士的出现,被称为协调护士。而在2018年,高级实践护理的出现导致了一个新的专业类别的创建,高级执业护士(APN)。护士协调员和APN在应对帕金森病带来的公共卫生挑战方面发挥着重要作用。他们是实施个性化护理途径的保证人,其目的是为患者提供最佳的生活质量。他们在城市的医疗服务和PEC之间建立了不可或缺的联系,与许多与帕金森病患者一起工作的医疗保健专业人员合作。
    The creation of Parkinson\'s expert centers (PEC) led to the emergence of new nurses, known as coordination nurses. And in 2018, the emergence of advanced practice nursing led to the creation of a new category of professionals, advanced practice nurses (APN). Nurses coordinators and APN play a major role in meeting the public health challenges posed by Parkinson\'s disease. They are the guarantors of the implementation of a personalized care pathway, the aim of which is to offer patients an optimized quality of life. They forge an indispensable link between the city\'s healthcare services and the PEC, collaborating with the many healthcare professionals who work with people suffering from Parkinson\'s disease.
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  • 文章类型: English Abstract
    经导管主动脉瓣植入术已成为老年人主动脉瓣置换术的首选方法。术前标准化老年评估(SGA)有助于指导决策,考虑手术风险评分不针对的老年病学参数。这是一个描述性的,在图卢兹大学医院接受EGS的患者的回顾性研究,分析他们的住院时间和术后护理途径。
    Transcatheter Aortic Valve Implantation has become the preferred method of aortic valve replacement in the elderly. Preoperative standardized geriatric assessment (SGA) helps guide the decision to proceed, taking into account geriatric parameters not targeted by surgical risk scores. This is a descriptive, retrospective study of patients who underwent EGS at the Toulouse University Hospital, analyzing their length of stay and postoperative care pathway.
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