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Vernet A.,Center Hospitalier George Sand | Henin M.,Center Hospitalier Of Blois | Alexandre C.,Center Hospitalier Of Vichy | Agboli K.,Center Hospitalier George Sand | And 3 more authors.
Information Psychiatrique | Year: 2014

Sexual relations in the Psychiatry Department. The practice of sexual relations, in whatever institution, is always a problem, but more so in psychiatric institutions because of the vulnerability of the patients who are admitted and changes in their capacity to consent. A recent court decision was clear, on the one hand it considered the status of sexuality (which is a fundamental freedom, i.e. the participant's right to privacy) and on the other the hypothesis that such a right may be restricted (motivated by legitimate purposes and in compliance with the principle of proportionality). This judicial decision considered that there can be no general prohibition and in principle any restrictions should always be adapted to each individual case. Copyright © 2014 John Libbey Eurotext.


Dion F.,University of Tours | Saudeau D.,University of Tours | Bonnaud I.,University of Tours | Friocourt P.,Center Hospitalier Of Blois | And 6 more authors.
Journal of Interventional Cardiac Electrophysiology | Year: 2010

Purpose: Ischemic stroke is a frequent pathology with high rate of recurrence and significant morbidity and mortality. There are several causes of stroke, affecting prognosis, outcomes, and management, but in many cases, the etiology remains undetermined. We hypothesized that atrial fibrillation was involved in this pathology but underdiagnosed by standard methods. The aim of the study was to determine the incidence of atrial fibrillation in cryptogenic ischemic stroke by using continuous monitoring of the heart rate over several months. The secondary objective was to test the value of atrial vulnerability assessment in predicting spontaneous atrial fibrillation. Methods and results: We prospectively enrolled 24 patients under 75 years of age, 15 men and 9 women of mean age 49 years, who within the last 4 months had experienced cryptogenic stroke diagnosed by clinical presentation and brain imaging and presumed to be of cardioembolic mechanism. All causes of stroke were excluded by normal 12-lead ECG, 24-h Holter monitoring, echocardiography, cervical Doppler, hematological, and inflammatory tests. All patients underwent electrophysiological study. Of the patients, 37.5% had latent atrial vulnerability, and 33.3% had inducible sustained arrhythmia. Patients were secondarily implanted with an implantable loop recorder to look for spontaneous atrial fibrillation over a mean follow-up interval of 14.5 months. No sustained arrhythmia was found. Only one patient had non-significant episodes of atrial fibrillation. Conclusion: In this study, symptomatic atrial fibrillation or AF with fast ventricular rate has not been demonstrated by the implantable loop recorder in patients under 75 years with unexplained cerebral ischemia. The use of this device should not be generalized in the systematic evaluation of these patients. In addition, this study attests that the assessment of atrial vulnerability is poor at predicting spontaneous arrhythmia in such patients. © The Author(s) 2010.


Houot R.,University of Rennes 1 | Le Gouill S.,University of Nantes | Le Gouill S.,French Institute of Health and Medical Research | Uribe M.O.,Center Hospitalier Of Mulhouse | And 18 more authors.
Annals of Oncology | Year: 2012

Background: There is no consensual first-line chemotherapy for elderly patients with mantle cell lymphoma (MCL). The GOELAMS (Groupe Ouest-Est des Leucémies Aiguë s et Maladies du Sang) group previously developed the (R)VAD+C regimen (rituximab, vincristine, doxorubicin, dexamethasone and chlorambucil), which appeared as efficient as R-CHOP (rituximab, cyclophosphamide, doxorubicine, vincristine, prednisone) while less toxic. Based on this protocol, we now added bortezomib (RiPAD+C: rituximab, bortezomib, doxorubicin, dexamethasone and chlorambucil) given its efficacy in relapsed/refractory MCL patients. The goal of the current phase II trial was to evaluate the feasibility and efficacy of the RiPAD+C regimen as frontline therapy for elderly patients with MCL. Patients and methods: Patients between 65 and 80 years of age with newly diagnosed MCL received up to six cycles of RiPAD+C. Results: Thirty-nine patients were enrolled. Median age was 72 years (65-80). After four cycles of RiPAD+C, the overall response rate was 79%, including 51% complete responses (CRs). After six cycles, CR rate increased up to 59%. After a 27-month follow-up, median progression-free survival (PFS) is 26 months and median overall survival has not been reached. Four patients (10%) discontinued the treatment because of a severe toxicity and seven patients (18%) experienced grade 3 neurotoxicity. Conclusion: The bortezomib-containing RiPAD+C regimen results in high CR rates and prolonged PFS with predictable and manageable toxic effects in elderly patients with MCL. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Denis-Delpierre N.,Nantes University Hospital Center | Denis-Delpierre N.,University of Nantes | Mallet D.,Center Hospitalier Of Luynes | Mallet D.,University of Tours | And 3 more authors.
Medecine Palliative | Year: 2016

Purpose: In a national context where one seeks to develop palliative care through training, we conducted an experiment on the development of the resident's interpersonal skills when they performed their clinical rotation in a palliative care's structure. Methods: Initially, we sought to understand conceptually and practically the various roles of interpersonal skills in palliative care. Then, we identified typical situations in which the relational dimension is sought. Thirdly, we analyzed the relational competencies and categorized them by skills. Results: Once this work completed, we defined educational tools and developed an identification guide of development of these relational competencies. Conclusion: Upon this experimentation, we reread our entire journey by releasing four benchmarks. It seems particularly important for the resident to develop his/her capabilities by exchanging with peers or relying on pedagogy research. These reflections have no normative value proposals or recommendations. They are to be considered as an educational experience in a field so far little explored. © 2016 Elsevier Masson SAS.


Montmasson H.,Center Hospitalier Of Blois | Bertrand P.,Pole dImagerie | Perrotin F.,Center Olympe Of Gouges | Perrotin F.,University of Tours | El-Hage W.,University of Tours
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2012

Objectives: Identify the potential predictors of postpartum post-traumatic stress disorder (PTSD) in primiparous mothers. Materials and methods: This longitudinal prospective study evaluated the prevalence of obstetric complications and psychiatric disorders (anxiety, depression, psychic dissociation, PTSD, personality) in the immediate postpartum and after 3-6 months. Results: Among 456 hospitalized primiparous mothers, 314 were recruited and 212 followed-up prospectively. The prevalence of PTSD symptoms was high and stable through the postpartum (12.7% versus 13.6%). Significant risk factors were associated with postpartum PTSD: social isolation, celibacy or divorce (OR = 6.6; P < 0.02), history of abortion (OR = 6.2; P < 0.01) or of infertility (OR = 10.4; P < 0.007), too long subjective length of labour (OR = 3.5; P < 0.03), mothers' perceptions of obstetric complications (OR = 18.5; P < 0.003), high anxiety level at the maternity hospital (OR = 3.9; P < 0.03), PTSD symptoms after childbirth (OR = 6.7; P < 0.01) and dependent personality disorder (OR = 23.2; P < 0.001). Conclusion: Subjective experience of childbirth, history of obstetric complications, social isolation and dependent personality disorder and high level of stress-anxiety after childbirth are significant predictive factors of postpartum PTSD (3-6 months). The early identification of these factors should lead to early therapeutic intervention in the mothers at risk of PTSD. © 2012 Elsevier Masson SAS.


Mallet D.,Ufr Francois Rabelais Of La Region Center | Chaumier F.,Unite mobile daccompagnement et de soins palliatifs | Hirsch G.,Center Hospitalier Of Blois
Medecine Palliative | Year: 2015

Claeys-Léonetti connection with the proposal to create a "right to continuous deep sedation" reactive discussions on the legal framework and the end of life. As caregivers working in palliative care teams, is it possible to formulate some thoughts or tracks to adopt if this bill is passed? If one relies on the text of the proposed law, the right to continuous deep sedation does not affect the current classification of medical decisions. However, it undermines attention to the uniqueness of the individual by imposing a regulatory framework for clinical practice. If one is interested in the application of this law, it will be difficult to apply in the current state of the organization of the health system. The complexity of the practice of sedation requires significant training effort, individual and collective, combined with an adjustment of human resources. On a societal level, in parallel with the introduction of a new law in connection with the patient's self-determination, the law introduces a new concept, a potential standard or extensive requirement: the "right to a fitting and soothed end". The legitimate aspiration, but maybe utopian, a peaceful end of life is returned in the medical field with the imperative of drug response. This approach follows a reductive reading of the end of life, confining the relief areas by pharmacological and application of a legal framework. © 2015 Elsevier Masson SAS.


Kuzzay M.-P.,Center Hospitalier Of Blois | Emonet M.,Center Hospitalier Of Blois | Montagutelli E.,Center Hospitalier Of Blois | Husson J.-F.,Center Hospitalier Of Blois | Harnois C.,Center Hospitalier Of Blois
Journal de Pharmacie Clinique | Year: 2015

Pharmaceutical analysis is an intermediate key step in securing drug therapy and can contribute to the reduction of avoidable iatrogenic related to health products. The objective of this study is to draw up the report of a 18-month systematized pharmaceutical analysis and consider how to implement to gain efficiency and relevance of this activity in a 1.300-bed general hospital without dedicated resources. Method. The pharmaceutical analysis generates pharmaceutical interventions (PI). We have studied and ranked the PI followed by prescribers in four main categories: right prescription (regimen dose, appropriate use, contraindicated and not recommended associations); mastery of the computer tool; adjustment to renal function (monitoring at every prescription change); other themes (full compliance with the therapeutic notebook, allergies). Results. Over 18 months, 2.336 PI were followed on 3.959 PI issued (59%): 1.757 IP followed in medicine-surgery and obstetric sector (12.5% of prescriptions); 472 in EHPAD-USLD-SSR (28%); 107 in psychiatry (22%). These gathered PI are divided as follows: 54% of right prescription; 25% of insufficient computer skills; 11% of dose adjustment to renal function; 10% of other themes. Pharmaceutical validation time is estimated at 39 hours per week. Discussion. This study shows that despite a recommended configuration (prescription and computerized tool for the integrated prescription), a high rate of non-compliance is noticed in the quality of prescribing. Since the lack of sufficient staff allowing pharmacists presence in the care services, standardization of PI and contractual pharmaceutical prescriptions should strengthen adherence of prescribers to PI. Conclusion. The drug prescription computerization is required, however, it is obviously insufficient to erase the iatrogenic drug risk. Pharmaceutical analysis is mandatory to ensure safety of the drug treatment in healthcare.


Friocourt P.,Center Hospitalier Of Blois
NPG Neurologie - Psychiatrie - Geriatrie | Year: 2011

The treatment of heart failure is the subject of guidelines issued by scientific societies and organizations. It uses a combination of non-pharmacological management, including education and influenza and pneumococcal vaccinations, and pharmacological therapy. Pharmacological treatment of heart failure with systolic dysfunction is well codified. It must include an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) and a betablocker, sometimes in combination with a diuretic, digoxin or an aldosterone antagonist. Too often, the titration of ACE inhibitors and betablockers is insufficient and recommended dosages are not met even in the absence of contraindication. This illustrates the concept of underuse in the elderly. Regular reassessment of treatment is necessary to try to achieve the target doses of betablockers, ACE inhibitors or angiotensin receptor antagonists, while avoiding adverse effects of therapy. The treatment of heart failure with preserved systolic function is poorly codified in the absence of convincing results of the studies. It is based on the use of diuretics in case of decompensation and the active management of risk factors and etiological disease (hypertension). © 2011 Elsevier Masson SAS.


Depla M.,University of Tours | d'Alteroche L.,University of Tours | Gouge A.,University of Tours | Moreau A.,University of Tours | And 12 more authors.
PLoS ONE | Year: 2012

Most clinical studies suggest that the prevalence and severity of liver steatosis are higher in patients infected with hepatitis C virus (HCV) genotype 3 than in patients infected with other genotypes. This may reflect the diversity and specific intrinsic properties of genotype 3 virus proteins. We analyzed the possible association of particular residues of the HCV core and NS5A proteins known to dysregulate lipid metabolism with steatosis severity in the livers of patients chronically infected with HCV. We used transmission electron microscopy to quantify liver steatosis precisely in a group of 27 patients, 12 of whom were infected with a genotype 3 virus, the other 15 being infected with viruses of other genotypes. We determined the area covered by lipid droplets in liver tissues and analyzed the diversity of the core and NS5A regions encoded by the viral variants circulating in these patients. The area covered by lipid droplets did not differ significantly between patients infected with genotype 3 viruses and those infected with other genotypes. The core and NS5A protein sequences of the viral variants circulating in patients with mild or severe steatosis were evenly distributed throughout the phylogenic trees established from all the collected sequences. Thus, individual host factors seem to play a much greater role than viral factors in the development of severe steatosis in patients chronically infected with HCV, including those infected with genotype 3 viruses. © 2012 Depla et al.


PubMed | Center Hospitalier Of Blois
Type: Evaluation Studies | Journal: Journal de gynecologie, obstetrique et biologie de la reproduction | Year: 2012

Identify the potential predictors of postpartum post-traumatic stress disorder (PTSD) in primiparous mothers.This longitudinal prospective study evaluated the prevalence of obstetric complications and psychiatric disorders (anxiety, depression, psychic dissociation, PTSD, personality) in the immediate postpartum and after 3-6 months.Among 456 hospitalized primiparous mothers, 314 were recruited and 212 followed-up prospectively. The prevalence of PTSD symptoms was high and stable through the postpartum (12.7% versus 13.6%). Significant risk factors were associated with postpartum PTSD: social isolation, celibacy or divorce (OR=6.6; P<0.02), history of abortion (OR=6.2; P<0.01) or of infertility (OR=10.4; P<0.007), too long subjective length of labour (OR=3.5; P<0.03), mothers perceptions of obstetric complications (OR=18.5; P<0.003), high anxiety level at the maternity hospital (OR=3.9; P<0.03), PTSD symptoms after childbirth (OR=6.7; P<0.01) and dependent personality disorder (OR=23.2; P<0.001).Subjective experience of childbirth, history of obstetric complications, social isolation and dependent personality disorder and high level of stress-anxiety after childbirth are significant predictive factors of postpartum PTSD (3-6 months). The early identification of these factors should lead to early therapeutic intervention in the mothers at risk of PTSD.

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