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Rwabihama J.-P.,Hopitaux Universitaires Henri Mondor
Ethique et Sante | Year: 2014

This is a tribute to Edmund Pellegrino, professor of internal medicine and medical ethics at Georgetown University, died at age of 92after more than 65years in medicine and university administration. His research work, focused on the doctor-patient relationship, human dignity and bioethics challenges, have been published in more then 20books and 600scientific articles. This text aims to honor his memory and underline some points of his philosophy applied to medicine. © 2014 .

Gilioli C.,Hopitaux Universitaires Henri Mondor
Soins Cadres de Sante | Year: 2014

Supporting a student in the production of a dissertation in particular goes beyond technical and methodological support, it is a moral commitment. Considering the ethical dimension of such a situation which is by defi nition limited and temporary comes down to analysing an active commitment which is not often examined. It is therefore necessary to agree before any development on what the very concept of ethics means in order to be able to consider the moral implications of what such an activity is bound to arouse © 2014 Elsevier Masson SAS. All rights reserved.

Hutin E.,Hopitaux Universitaires Henri Mondor
NeuroRehabilitation | Year: 2013

BACKGROUND: High intensity and early initiation of rehabilitation have been extensively demonstrated to enhance neural plasticity and motor recovery after stroke. However, the optimal duration of rehabilitation programs in order to have the highest impact on motor outcomes has not been established. OBJECTIVES: To evaluate motor outcomes in subacute stroke survivors with moderate to severe upper limb paresis over an extended period of rehabilitation consisting of usual care augmented with a large number of upper limb robot-assisted sessions (54 ± 13 sessions). METHODS: Retrospective study in 10 inpatients. RESULTS: The results showed a gradual decrease in motor and functional impairments throughout the training period with a clinically meaningful increase in the Fugl-Meyer Assessment scores and in the Motor Status Scores (1st vs 37th day of the training, FMA,+ 48%, p = 0.018, MSS,+ 64%, p = 0.012; 37th vs. 79th day, FMA,+ 23%, p = 0.012, MSS,+ 30%, p = 0.017). In addition, there were improvements in hand kinematics recorded by the robot during a pointing task, with quantitative improvement (1st vs 40th day, movement efficacy,+ 97%, p = 0.0499; hand velocity,+ 335%, p = 0.013) prior to qualitative improvement (1st vs 80th day, number of hand trajectory reversals, -50%, p = 0.028; root mean square error of the trajectory/linear displacement, -52%, p = 0.059). CONCLUSIONS: Although this study was a retrospective analysis of a small sample of patients, the results suggested that a prolonged period of intensive upper limb rehabilitation, including robot-assisted training incorporated into a multidisciplinary program throughout the subacute phase after stroke resulted in significant improvements in patients with moderate to severe motor impairments. © 2013 - IOS Press and the authors. All rights reserved.

Gilioli C.,Hopitaux Universitaires Henri Mondor
Soins Psychiatrie | Year: 2015

Mental disorders lead patients along paths of irrationality. Insanity is perceived as excessiveness, often associated with violence. Risk in psychiatry is omnipresent and nursing practice is performed within a narrow safety zone. The media coverage of sensitive situations does not help. Ensuring the patient's recovery, respecting the fundamental principles of individual freedom while assuring the utmost safety of others is the constant challenge facing caregivers in psychiatry. © 2015 Elsevier Masson SAS.

Mekontso Dessap A.,Hopitaux Universitaires Henri Mondor | Mekontso Dessap A.,University Paris Est Creteil
Reanimation | Year: 2016

Volume overload is frequently encountered in intensive care unit patients, especially in patients with sepsis and/or mechanical ventilation. Volume overload is associated with a prolongation of mechanical ventilation in general and of the weaning period in particular. It is a major contributing factor to cardiovascular weaning failure, including failed spontaneous breathing trial and failed extubation. A strategy of restrictive fluid management shortens the duration of mechanical ventilation, including weaning length. © 2016, Société de réanimation de langue française (SRLF) and Springer-Verlag France.

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