Penser l'éthique clinique à partir de l'oeuvre de Kostas Axelos

Our thesis project is a continuation of a work undertaken in a dissertation of clinical ethics: the challenge was in particular to clarify the problem of the foundation of ethics. Indeed, ethics is exposed to a deep crisis that is more broadly that of the modes of production of norms of truth in the axiological field. Where do these shared values lie? In the twin traces of Marx and Heidegger and attempting a breakthrough beyond this post-metaphysical legacy, the work of Kostas Axelos (1924-2010) raises the question of the meaning of ethics and its foundations in the face of the growing threat of nihilism. In the framework of this work, our research project deals with the determination of the characteristics of axelian ethics and its possible uses in the context of expertise in clinical ethics (ethical dilemmas).Notre projet de thèse s'inscrit dans le prolongement d'un travail engagé dans un mémoire de diplôme d'éthique clinique: l'enjeu en était notamment d'éclaircir le problème du fondement de l'éthique. L'éthique est en effet exposée à une crise profonde qui est plus largement celui des modes de production des normes de vérité dans le domaine axiologique. Sur quoi reposent ces valeurs partagées? Dans le double sillage de Marx et de Heidegger et tentant une percée par delà cet héritage post-métaphysique, l'oeuvre de Kostas Axelos (1924-2010) pose la question du sens de l'éthique et de ses fondements face à la menace grandissante du nihilisme. Dans le cadre de cette oeuvre, notre projet de recherche porte sur la détermination des caractéristiques de l'éthique axelienne et sur ses possibles usages dans le cadre d'expertises en éthique clinique (dilemmes éthiques)

Utilisation du Midazolam et sédation en soins palliatifs: quel paradoxe entre pratique soignante et sens du soins?

Conclusion de l'étude: - La sédation provoque une souffrance psychologique et morale chez les soignants qui s’interrogent sur ce qu’ils font- La sédation remet en question la compétence soignante dans ses actions- Le travail en équipe est la condition pour réduire cette incertitudeDécrire les expériences et explorer les perceptions de l’usage du Midazolam et de la pratique de la sédation . Comprendre les représentations de la sédation et leur impact sur les pratiques de soin. méthodes de recueil des données:Focusgroups, Récits cliniques, Observations participantesDeux méthodes d’analyse des données: analyse thématique des verbatim, analyse lexical

Utilisation du Midazolam et sédation en soins palliatifs: quel paradoxe entre pratique soignante et sens du soins?

Conclusion de l'étude: - La sédation provoque une souffrance psychologique et morale chez les soignants qui s’interrogent sur ce qu’ils font- La sédation remet en question la compétence soignante dans ses actions- Le travail en équipe est la condition pour réduire cette incertitudeDécrire les expériences et explorer les perceptions de l’usage du Midazolam et de la pratique de la sédation . Comprendre les représentations de la sédation et leur impact sur les pratiques de soin. méthodes de recueil des données:Focusgroups, Récits cliniques, Observations participantesDeux méthodes d’analyse des données: analyse thématique des verbatim, analyse lexical

Barriers to end-of-life discussions among hematologists: A qualitative study

Background: Integrated palliative care is correlated with earlier end-of-life discussion and improved quality of life. Patients with haematological malignancies are far less likely to receive care from specialist palliative or hospice services compared to other cancers. Aim: The main goal of this study was to determine hematologists’ barriers to end-of-life discussions when potentially fatal hematological malignancies recur. Design: Qualitative grounded theory study using individual interviews. Setting/participants: Hematologists (n = 10) from four hematology units were asked about their relationships with their patients and their attitudes toward prognosis and end-of-life discussions at the time of recurrence. Results: As long as there are potential treatments, hematologists fear that end-of-life discussions may undermine their relationship and the patient’s trust. Because of their own representations, hematologists have great difficulty opening up to their patients’ end-oflife wishes. When prognosis is uncertain, negative outcome, that is, death, is not fully anticipated. Persistent hope silences the threat of death. Conclusion: This study reveals some of the barriers clinicians face in initiating early discussion about palliative care or patients’ endof- life care plan. These difficulties may explain why early palliative care is little integrated into the hematology care model

Added value of functional neuroimaging to assess decision-making capacity of older adults with neurocognitive disorders: protocol for a prospective, monocentric, single-arm study (IMAGISION)

International audienceIntroduction Assessment of decision-making capacity (DMC) is essential in daily life as well as for defining a person-centred care plan. Nevertheless, in ageing, especially if signs of dementia appear, it becomes difficult to assess decision-making ability and raises ethical questions. Currently, the assessment of DMC is based on the clinician’s evaluation, completed by neuropsychological tests. Functional MRI (fMRI) could bring added value to the diagnosis of DMC in difficult situations. Methods and analysis IMAGISION is a prospective, monocentric, single-arm study evaluating fMRI compared with clinical assessment of DMC. The study will begin during Fall 2021 and should be completed by Spring 2023. Participants will be recruited from a memory clinic where they will come for an assessment of their cognitive abilities due to decision-making needs to support ageing in place. They will be older people over 70 years of age, living at home, presenting with a diagnosis of mild dementia, and no exclusion criteria of MRI. They will be clinically assessed by a geriatrician on their DMC, based on the neuropsychological tests usually performed. Participants will then perform a behavioural task in fMRI (Balloon Analogue Risk Task) to analyse the activation areas. Additional semistructured interviews will be conducted to explore real life implications. The main analysis will study concordance/discordance between the clinical classification and the activation of fMRI regions of interest. Reclassification as ‘capable’, based on fMRI, of patients for whom clinical diagnosis is ‘questionable’ will be considered as a diagnostic gain. Ethics and dissemination IMAGISION has been authorised by a research ethics board (Comité de Protection des Personnes, Bordeaux, II) in France, in accordance with French legislation on interventional biomedical research, under the reference IDRCB number 2019-A00863-54, since 30 September 2020. Participants will sign an informed consent form. The results of the study will be presented in international peer-reviewed scientific journals, international scientific conferences and public lectures. Trial registration number NCT03931148NCT03931148

Iron excess limits HHIPL-2 gene expression and decreases osteoblastic activity in human MG-63 cells.

International audienceIn order to understand mechanisms involved in osteoporosis observed during iron overload diseases, we analyzed the impact of iron on a human osteoblast-like cell line. Iron exposure decreases osteoblast phenotype. HHIPL-2 is an iron-modulated gene which could contribute to these alterations. Our results suggest osteoblast impairment in iron-related osteoporosis. INTRODUCTION: Iron overload may cause osteoporosis. An iron-related decrease in osteoblast activity has been suggested. METHODS: We investigated the effect of iron exposure on human osteoblast cells (MG-63) by analyzing the impact of ferric ammonium citrate (FAC) and iron citrate (FeCi) on the expression of genes involved in iron metabolism or associated with osteoblast phenotype. A transcriptomic analysis was performed to identify iron-modulated genes. RESULTS: FAC and FeCi exposure modulated cellular iron status with a decrease in TFRC mRNA level and an increase in intracellular ferritin level. FAC increased ROS level and caspase 3 activity. Ferroportin, HFE and TFR2 mRNAs were expressed in MG-63 cells under basal conditions. The level of ferroportin mRNA was increased by iron, whereas HFE mRNA level was decreased. The level of mRNA alpha 1 collagen type I chain, osteocalcin and the transcriptional factor RUNX2 were decreased by iron. Transcriptomic analysis revealed that the mRNA level of HedgeHog Interacting Protein Like-2 (HHIPL-2) gene, encoding an inhibitor of the hedgehog signaling pathway, was decreased in the presence of FAC. Specific inhibition of HHIPL-2 expression decreased osteoblast marker mRNA levels. Purmorphamine, hedgehog pathway activator, increased the mRNA level of GLI1, a target gene for the hedgehog pathway, and decreased osteoblast marker levels. GLI1 mRNA level was increased under iron exposure. CONCLUSION: We showed that in human MG-63 cells, iron exposure impacts iron metabolism and osteoblast gene expression. HHIPL-2 gene expression modulation may contribute to these alterations. Our results support a role of osteoblast impairment in iron-related osteoporosis