Cabinet Medical

Caen, France

Cabinet Medical

Caen, France
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Bichsel N.,Cabinet Medical | Conus P.,Service de Psychiatrie Generale
Revue Medicale Suisse | Year: 2017

Stigmatisation is a well known social phenomenon based on the discrimination of an individual or a sub- group of individuals by a dominant or majority group. Often discussed in the frame of psychiatry, it is also observed in other domains of medicine. It impacts not only patients, but their relatives and their children, as well as the health professionals taking care of them. Moreover, it is detrimental to the implementation of preventive strategies and induces depressive reactions, loss of self esteem and reduction of patients' quality of life. Finally, it keeps researchers away from certain domains of medicine and has a negative impact on funding for research and treatment. It is therefore important to understand its underlying mechanisms in order to fight it more efficiently.

The role of peritraumatic distress in the genesis of PTSD, although well established and explicit in the DSM criteria, seems to be undervalued by the main theoretical conceptualizations of PTSD. Most models explain the presence of a large variety of emotions other than fear as subsequent to the reinterpretation of the traumatic event. Exposure strategies implemented in the case study illustrate the unexpected appearance of strong feelings of distress in the face of trauma-related sensations and situations and lead us to postulate the primacy of these emotions as well as the role of the avoidance of these same emotions in the genesis of disorders. This hypothesis corroborates the innovations of third generation cognitive and behavioral therapy, which underlines the role of emotions as well as the avoidance of emotions in the development of persistent mood disorders. © 2011 Association française de thérapie comportementale et cognitive.

Montes H.,Cabinet Medical
Journal de Therapie Comportementale et Cognitive | Year: 2016

In response to the terrorist attacks of November 2015 in Paris, more than one hundred Cognitive Behavioral psychotherapists, members of the French Association of Cognitive Behavioral Therapy (Association Française de Thérapie Comportementale et Cognitive [AFTCC]), offered immediate, free psychological assistance to victims. This generous action provided therapists with the opportunity to consider the importance of developing creativity and flexibility in their own individual practice. It was also the opportunity for an association the size of the AFTCC to reflect on the assistance and services it provides to its members. © 2015 Association française de thérapie comportementale et cognitive.

Devonshire V.,University of British Columbia | Lapierre Y.,Hopital Neurologique de Montreal | Macdonell R.,Austin Hospital | Ramo-Tello C.,Hospital Universitario Germans Trias jol Servicio Of Neurologia | And 7 more authors.
European Journal of Neurology | Year: 2011

Background: Most disease-modifying therapies (DMTs) for multiple sclerosis (MS) are self-injectable medications that must be taken on an ongoing basis to reduce disease activity. Thus, adherence to therapy becomes an important challenge that must be addressed to maximize benefits of therapy. This study evaluated rates of adherence to prescribed treatment and explored factors affecting adherence amongst patients with relapsing-remitting MS.Methods: This was an observational, multicenter, multinational, phase 4 study. Patients and physicians received paper questionnaires regarding adherence to DMTs approved at the time of the study, including intramuscular interferon beta-1a (IFNβ-1a), subcutaneous IFNβ-1a, IFNβ-1b, and glatiramer acetate. Quality of life and cognition data also were collected. Multivariate analysis was conducted to identify factors associated with adherence to long-term DMTs.Results: Two thousand six hundred and forty-eight patients were studied, revealing an average treatment duration of 31 months. Seventy-five percent of patients (n = 1923) were adherent to therapy. The most common reasons for non-adherence were forgetting to administer the injection (50.2%) and other injection-related reasons (32.0%). Adherent patients reported better quality of life (P < 0.05) and fewer neuropsychological issues (P < 0.001) than non-adherent patients. Adherent patients had significantly shorter duration of disease (P < 0.001) and shorter duration of therapy (P = 0.005) than non-adherent patients. Women were more likely than men to adhere to treatment.Conclusion: Identifying factors that affect adherence to prescribed treatments is the first step in improving adherence of patients with MS to therapy, thereby helping maximize the benefits of long-term DMTs. © 2010 The Author(s). European Journal of Neurology © 2010 EFNS.

Gaillard Y.P.,Laboratory of Analytical Toxicology | Cuquel A.-C.,Laboratory of Analytical Toxicology | Boucher A.,Center dEvaluation et dInformation sur la Pharmacodependance | Romeuf L.,Laboratory of Analytical Toxicology | And 3 more authors.
Journal of Forensic Sciences | Year: 2013

A 20-year-old man, a cocaine addict and regular ecstasy user, with a medical history of allergic asthma died after ingesting half a tablet earlier the same day. The white tablet, stamped with a "smiling sun" logo looked very much like an ecstasy tablet and was sold as such. He experienced a severe asthma attack just after ingesting the half tablet and it evolved over the next few hours into fatal cardiorespiratory arrest. Biological samples, taken after embalming, were analyzed by high-performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). Analysis revealed meta-chlorophenylpiperazine (mCPP) in concentrations of 45.8 mg in a similar tablet obtained later from the drug dealer, 5.1 ng/mL in the bile, 0.3 ng/g in the liver, 15.0 ng/mL in the urine, and its absence in a hair sample (<0.02 ng/mg), which indicated he was not a regular user (whereas strong concentrations of MDMA and cocaine were found in the hair). Interrogated by the police after his arrest, the dealer said that he had sold the victim and for the very first time two tablets with the same "smiling sun" logo. The tablet used for analysis was from the same brand as the one ingested by the victim. The autopsy excluded other causes of death, while the histological analyses showed a large number of polynuclear eosinophils in the bronchial walls, confirming the asthmatic pathology. None of the other organs examined (larynx, liver, heart, adrenal glands, and kidneys) showed any distinctive signs, and in particular no inflammatory infiltrate. The death was the result of an asthma attack in an asthmatic person, violently decompensated following ingestion of approximately 20 mg of mCPP. © 2012 American Academy of Forensic Sciences.

Analysis purpose: This analysis has allowed to document, in a practical manner, the patients' clinical and sensitization profiles, and to identify the grounds in establishing or not a specific sublingual immunotherapy (SLIT). Patients and methods: National, longitudinal multicenter survey, performed in patients from 5 years old, whose allergy was confirmed by skin test or specific IgE testing. Sociodemographic data, history of allergy and the considered therapeutic approach were gathered in a registry from September 2009 to March 2010, and then analyzed. Results: Amongst 4227 patients registered by 264 physicians, 62% were polysensitized, 80.4% had several symptoms of respiratory allergy, including rhinitis (98.2%) mostly persistent and with moderate to severe intensity; conjunctivitis (65,5%) and asthma (48.1%) intermittent in 69% of cases. About 94.3% of patients had symptomatic treatments, moderate or insufficient effectiveness for 68.5% of them. A SLIT has been initiated in 65% of cases. The presence of conjunctivitis and sensitization to Betulaceae or cypress pollen increased the probability of initiating a SLIT, whereas polysensitization was not a determinant factor. Insufficient symptomatic complain, patient's treatment refusal or predictable poor compliance were the main reasons for not initiating a SLIT. Conclusion: The results of this registry have testified, in practice, the compliance with the ARIA recommendations in the decision establishing a SLIT: treatment was proposed to young patients suffering from moderate to severe rhinitis, with an important discomfort and inadequately relieved by symptomatic treatments. © 2010.

Delage J.-M.,Cabinet medical | Vassal P.,Service de soins palliatifs
Ethique et Sante | Year: 2012

For two years, Germaine centenary in institutions hosting the frail elderly (nursing homes) without pain and cries for no reason. How can I make? Reference texts do not provide an answer. We surveyed caregivers - doctors coordinators, nurse coordinators - EHPAD. The resident crier is a reality, 5% of seniors living in institutions. This disorder of verbal behavior is not isolated. It comes to the topic Crier physical disorders - agitation, falls, insomnia. And more it will impact the structure and its environment: non-criers residents, families, caregivers, neighbors. Nonsense - cry lived as a double failure of communication - that cry may make sense for 93% of caregivers surveyed. Nevertheless, the crier about the risk of losing the caregivers referred by an ethic of care attitude of abuse set to music in a measure to four times: on medical drugs, isolation, denial of admission, and mutation of topics criers. The ethical principles of autonomy, beneficence and justice are then undermined. The cry is to rebel psychotropic but softens in linking. The main role of caregivers taking care topics criers is to maintain a link human interconstantly questioned. © 2012 Elsevier Masson SAS.

Since Ricœur we have been aware that personal identity combines idem (sameness)/permanence and ipse/promise. Whereas sameness without evolution, without adaptation, plunges the subject into retention, either obsessive or paranoiac, the pure individuality from the "Man without Qualities" (Musil) leads to his fragmentation, to the loss of his outer cover, towards depression or schizophrenia. On the other hand, if identity forms a human being, it is through the alliance between location and history, by establishing an interaction between marks and codes. We ought to think about the possible disturbances of the migratory link of identity to location and history, vicissitudes of human being between utopia, dystopia and heterotopia, outlining an elementary phenomenological approach.

Uzan C.,University Pierre and Marie Curie | Seror J.-Y.,Imagerie Duroc | Seror J.,Cabinet Medical
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2015

Breast cysts are common, often discovered incidentally or subsequently to pain orpalpable mass. The purpose of these recommendations is to describe the sonographic findingsfor classifying breast cystic lesions, to analyze the value and contribution of various imagingtechniques and sampling and to provide a management strategy.Materials and methods.-Literature review conducted by a small group and then reviewed andvalidated by the group designated by the Collège national des gynécologues et obstétriciensfrancąis (CNGOF) to make recommendations for clinical practice for benign breast lesions.Results.-Breast cysts are classified in 3 categories: simple cysts, complicated cysts and com-plex cysts. For simple cysts, after ultrasound, no further imaging is necessary, cytology is toconsider only as analgesic. For complicated cysts, a control at 4-6 months is recommended; theuse of cytology depends on the context (familial risk, difficulty of follow-up). In case of complexcyst, sampling by cytology or biopsy is recommended. More assessments of other imaging testsare reported. Conclusion.-The sonographic characterization is essential for management of breast cyst. © 2015 Elsevier Masson SAS.

Gremeaux V.,Pole Reeducation Readaptation | Viviez T.,Cabinet Medical | Bousquet P.,Nimes University Hospital Center | Coudeyre E.,Clermont University
Spine | Year: 2012

Study Design.: Cross-sectional study of teaching general practitioners (TGPs) in the South of France. Objective.: To determine what TGPs think about francophone Internet sites dedicated to chronic low back pain (CLBP). Summary of Background Data.: Patients with CLBP often seek medical information about their symptoms on the Internet. The quality of the information is usually poor. To date, the opinion of TGPs concerning the quality of CLBP Web sites remains unknown. Methods.: We invited the 112 TGPs in the Southern region to participate. The participants used an assessment scale to evaluate 7 Web sites about CLBP in semicontrolled conditions. The quality and the importance of the different types of information (medical, nonmedical) and the design were measured on a visual analog scale (0-100) and with the point-sharing method (scale of 0-10). Results.: In total, 47 TGPs responded. The median quality score for the 7 Web sites was 50 (range 30-79). The score for medical information was 52.5 (10-80), for nonmedical information it was 60.4 (20-90), and for design it was 56.4 (30-85). For nonmedical information, the median relative weight was 4, and for both medical information and design it was 3. Conclusion.: French TGPs believe that CLBP Web sites should focus on nonmedical, practical advice; they consider the design at least as important as the medical information. This viewpoint seems to conflict in part with patients expectations. Good-quality and interactive Web sites could reduce this discordance. A list of approved sites should be available for general practitioners to recommend to their patients, to supplement information given during the consultation. © 2012, Lippincott Williams & Wilkins.

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