Quelles sont les interventions infirmières qui favorisent l'empowerment du patient douloureux chronique: travail de Bachelor

Contexte : Aujourd’hui, la douleur chronique qui touche 16% de la population suisse est une préoccupation pour le système de santé et les professionnels de santé. L’infirmière fait face à des patients informés, qui peuvent être des partenaires de leur prise en soin et qui demandent à être considérés dans leur globalité. Problématique : Comment l’infirmière peut-elle favoriser l’empowerment des patients afin de les rendre compétents dans la gestion de leur douleur chronique ? Méthode : Ce mémoire est une revue de la littérature de six articles scientifiques de 2010 à 2016, qui analysent ce qui est proposé actuellement aux patients pour autogérer leur douleur chronique et pose un regard sur le rôle infirmier. Résultats : Le patient a besoin de se sentir reconnu dans son vécu de douleur chronique par les professionnels de santé et par ses proches, ce qui impacte directement son bien-être. L’infirmière rend le patient/famille compétent en favorisant l’empowerment au travers d’un langage commun, l’évaluation de leurs ressources et un travail sur la systémique familiale. Conclusion : Les infirmières ont un rôle important à jouer dans la reconnaissance de ces douleurs chroniques. Le modèle McGill incluant le concept de personne/famille est un outil pour la prise en soin et favorise la collaboration soignant/soigné/famille.Background : Today, chronic pain, which affects 16% of the Swiss population, is a major concern for the health system and health professionals. Nurses are faced with informed patients, with whom they can work in partnership to provide care. These patients call for being considered in their totality. Research question : How can nurses promote the empowerment of patients in order to give them the skills to manage their own chronic pain? Methodology : This thesis is a literature review of six scientific articles published between 2010 to 2016, which analyze the methods that are currently suggested to patients for the self-management of their chronic pain. This thesis further addresses the nurse's role in this process. Results : The patient needs to feel that their chronic pain is recognized both by health professionals and their family support network, which impacts their well-being directly. The nurse helps the patient and their family to become competent by promoting empowerment through a common language, by assessing their resources, and by developing their family support network. Conclusion : Nurses have an important role to play in recognizing chronic pain. The McGill model including the concept of person/family is a useful tool for providing care that promotes collaboration between the caregiver, the patient, and their family

Multimodality Treatment with Conventional Transcatheter Arterial Chemoembolization and Radiofrequency Ablation for Unresectable Hepatocellular Carcinoma

Background/Aims: To evaluate the efficacy of multimodality treatment consisting of conventional transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) in patients with non-resectable and non-ablatable hepatocellular carcinoma (HCC). Methods: In this retrospective study, 85 consecutive patients with HCC (59 solitary, 29 multifocal HCC) received TACE followed by RFA between 2001 and 2010. The mean number of tumors per patient was 1.6 +/- 0.7 with a mean size of 3.0 +/- 0.9 cm. Both local efficacy and patient survival were evaluated. Results: Of 120 treated HCCs, 99 (82.5%) showed a complete response (CR), while in 21 HCCs (17.5%) a partial response was depicted. Patients with solitary HCC revealed CR in 91% (51/56); in patients with multifocal HCC (n = 29) CR was achieved in 75% (48 of 64 HCCs). The median survival for all patients was 25.5 months. The 1-, 2-, 3- and 5-year survival rates were 84.6, 58.7, 37.6 and 14.6%, respectively. Statistical analysis revealed a significant difference in survival between Barcelona Clinic Liver Cancer (BCLC) A (73.4 months) and B (50.3 months) patients, while analyses failed to show a difference for Child-Pugh score, Cancer of Liver Italian Program (CLIP) score and tumor distribution pattern. Conclusion: TACE combined with RFA provides an effective treatment approach with high local tumor control rates and promising survival data, especially for BCLC A patients. Randomized trials are needed to compare this multimodality approach with a single modality approach for early-stage HCC. Copyright (C) 2011 S. Karger AG, Base

Managing alternative sports: new organisational spaces for the diffusion of Italian parkour

The article explores the encounter between parkour as an unstructured and culturally innovative practice, challenging both physical as well as organisational spaces, and UISP (Unione Italiana Sport per Tutti / Sport for All Italian Union) as a sport promotion body open to organisational and cultural experimentation. Drawing on a multi-method qualitative approach (analysis of documentary material, interviews and focus groups), we look at the role of UISP in the diffusion and legitimation of parkour within the Italian context, investigating the interplay between the cultural and organisational logics of both this new practice itself on the one hand, and the organisations that are trying to accommodate it on the other. The incorporation in a sport-for-all organisation like UISP provides traceurs with a safe and legitimised space, which is however ‘loose’ enough to maintain the fluidity of the practice. Nonetheless, by enabling the coexistence of different and competing definitions and uses of parkour, this fluid organisational space reproduces tensions among traceurs and weakens their voice in UISP’s decision-making processes

Chatter stability analysis of boring process equipped with Tuned Mass Damper through linear time periodic dynamics

LAUREA MAGISTRALEIl fenomeno di instabilit`a rigenerativo, meglio conosciuto come Chatter rigenerativo, rappresenta uno dei fattori pi`u limitanti nei processi di asportazione di truciolo. Tale fenomeno porta ad una riduzione della produttivit`a, una riduzione della qualit`a del manufatto e un aumento dell’usura dell’utensile e delle parti della macchina. Nel corso degli anni sono stati pubblicati diversi studi atti a favorire lo sviluppo di strategie per sopprimere il Chatter ed estendere la conoscenza del fenomeno. L’obiettivo di questa Tesi, svolta in collaborazione con Pama S.P.A., `e studiare la stabilit`a di una lavorazione di alesatura quando un Tuned Mass Damper `e installato sull’utensile e ruota con esso. Il sistema in questione presenta caratteristiche asimmetriche dal punto di vista dinamico e non `e modellabile attraverso la Dinamica Lineare Tempo Invariante. Per la prima volta, il comportamento dinamico asimmetrico dell’utensile viene introdotto nel modello attraverso la funzione di variazione della rigidezza, che consente di modulare la dinamica del sistema in funzione della posizione dell’utensile stesso. L’ausilio della funzione di variazione della rigidezza aggiunge un fattore di complessit`a al modello e richiede l’approccio ai sistemi Lineari Tempo Periodici per studiare la stabilit`a del sistema. Il modello sviluppato `e stato applicato inizialmente a tre diverse casistiche, e successivamente esteso alla condizione di taglio interrotto. Il primo caso identifica l’analisi di stabilit`a di un processo di alesatura senza TMD, mediante dinamica Lineare Tempo Invariante. Questo caso rappresenta lo stato dell’arte del processo di alesatura e consente di definire il punto di partenza del lavoro svolto. Il secondo caso identifica l’analisi di stabilit`a attraverso descrizione dinamica LTI, e sottolinea come, questa modellazione della dinamica del sistema, non sia adatta a studiare la stabilit`a. L’ultimo caso, il numero tre, descrive il processo attraverso la dinamica LTP e fornisce il miglior compromesso in termini di stima della stabilit`a. Quest’ultimo caso `e stato esteso anche alle condizioni di taglio interrotto. I risultati ottenuti sono stati testati attraverso validazioni sperimentali e numeriche.Chatter is one of the most limiting factors in chip removal processes. This instability phenomenon leads to a reduction in productivity, a reduction in quality, and an increase in the wear of tool and machine parts. Over the years, different studies have been published which led to the development of strategies to suppress Chatter and extend the know-how about the phenomenon. The goal of this Thesis, conducted in collaboration with Pama S.P.A., is to study the stability of the Boring process when a Tuned Mass Damper is installed on a boring tool and rotates with it. The system in question presents asymmetric characteristics from a dynamical point of view, and cannot be modeled through Linear Time Invariant Dynamics. For the first time, the asymmetric behaviour will be introduced in the model through the Stiffness Variation function, which allows modulating the dynamics of the system in function of the position of the boring tool. The aid of the Stiffness Variation function adds a factor of complexity to the model and requires Linear Time Periodic laws to study the stability of the system. The model developed was applied firstly to three different applications, and after was extended to interrupted cutting conditions. The first case identifies the stability analysis of boring operation without TMD through Linear Time Invariant dynamics. This case represents the state of the art of boring process and allows to define the starting point of the work conducted. The second case identifies the stability analysis of the boring process with TMD through LTI dynamics and remarks the fact that, this dynamics description, does not model correctly the process. The last case, number three, describes the process through LTP dynamics and provides the best compromise in terms of Chatter stability estimation. This last case was extended also to interrupted cutting conditions. All the results obtained were tested through experimental and numerical validations

Ischaemic strokes in patients with pulmonary arteriovenous malformations and hereditary hemorrhagic telangiectasia: associations with iron deficiency and platelets.

<div><p>Background</p><p>Pulmonary first pass filtration of particles marginally exceeding ∼7 µm (the size of a red blood cell) is used routinely in diagnostics, and allows cellular aggregates forming or entering the circulation in the preceding cardiac cycle to lodge safely in pulmonary capillaries/arterioles. Pulmonary arteriovenous malformations compromise capillary bed filtration, and are commonly associated with ischaemic stroke. Cohorts with CT-scan evident malformations associated with the highest contrast echocardiographic shunt grades are known to be at higher stroke risk. Our goal was to identify within this broad grouping, which patients were at higher risk of stroke.</p><p>Methodology</p><p>497 consecutive patients with CT-proven pulmonary arteriovenous malformations due to hereditary haemorrhagic telangiectasia were studied. Relationships with radiologically-confirmed clinical ischaemic stroke were examined using logistic regression, receiver operating characteristic analyses, and platelet studies.</p><p>Principal Findings</p><p>Sixty-one individuals (12.3%) had acute, non-iatrogenic ischaemic clinical strokes at a median age of 52 (IQR 41–63) years. In crude and age-adjusted logistic regression, stroke risk was associated not with venous thromboemboli or conventional neurovascular risk factors, but with low serum iron (adjusted odds ratio 0.96 [95% confidence intervals 0.92, 1.00]), and more weakly with low oxygen saturations reflecting a larger right-to-left shunt (adjusted OR 0.96 [0.92, 1.01]). For the same pulmonary arteriovenous malformations, the stroke risk would approximately double with serum iron 6 µmol/L compared to mid-normal range (7–27 µmol/L). Platelet studies confirmed overlooked data that iron deficiency is associated with exuberant platelet aggregation to serotonin (5HT), correcting following iron treatment. By MANOVA, adjusting for participant and 5HT, iron or ferritin explained 14% of the variance in log-transformed aggregation-rate (p = 0.039/p = 0.021).</p><p>Significance</p><p>These data suggest that patients with compromised pulmonary capillary filtration due to pulmonary arteriovenous malformations are at increased risk of ischaemic stroke if they are iron deficient, and that mechanisms are likely to include enhanced aggregation of circulating platelets.</p></div

Use of Nonabsorbable Staples for Urinary Diversion: A Step in the Wrong Direction

Background: The use of bowel segments incorporated into the urinary tract is well established in urological surgery. Objective: To describe and compare the use of absorbable and nonabsorbable staples for creation of a urine reservoir after radical cystectomy. Materials and Methods: This review is based on a systematic Medline search assessing the period 1950-2010. Results: Use of the autosuture stapling device for the construction of the urinary diversion significantly reduces operating time. Johnson and Fuerst reported its use for the first time to construct a ureteroileocutaneous urinary diversion in 1973. However, many studies demonstrated that exposed metal staples represent a nidus for stone formation when they are in direct contact with urine, particularly in urinary diversions such as Kock pouch and ileal conduit. Stone formation has been attributed in part to the use of nonabsorbable artificial materials, such as metal staples and Marlex mesh, strictures of the pouch and accumulation of mucus. The treatment options for pouch calculi include observation for spontaneous passage, extracorporeal shockwave lithotripsy, percutaneous or endoscopic lithotripsy/lithotomy. Conclusions: Historically, the mean time to stone formation with nonabsorbable material (staples, Marlex mesh) is 34 months. None of the studies on use of nonabsorbable staples in urinary diversion has such a long follow-up. Until further studies with more appropriate observation time are completed, the use of nonabsorbable staples for continent and noncontinent urinary diversion should be discouraged

Zoledronic acid induces a significant decrease of circulating endothelial cells and circulating endothelial precursor cells in the early prostate cancer neoadjuvant setting

Purpose: Published data demonstrated that zoledronic acid (ZOL) exhibits antiangiogenetic effects. A promising tool for monitoring antiangiogenic therapies is the measurement of circulating endothelial cells (CECs) and circulating endothelial precursor cells (CEPs) in the peripheral blood of patients. Our aim was to investigate the effects of ZOL on levels of CECs and CEPs in localized prostate cancer. Methods: Ten consecutive patients with a histologic diagnosis of low-risk prostate adenocarcinoma were enrolled and received an intravenous infusion of ZOL at baseline (T0), 28 days (T28) and 56 days (T56). Blood samples were collected at the following times: T0 (before the first infusion of ZOL), T3 (72 h after the first dose), T28, T56 (both just before the ZOL infusion) and T84 (28 days after the last infusion of ZOL) and CEC/CEP levels were directly quantified by flow cytometry at all these time points. Results: Our analyses highlighted a significant reduction of mean percentage of CECs and CEPs after initiation of ZOL treatment [p = 0.014 (at day 3) and p = 0.012 (at day 84), respectively]. Conclusion: These preliminary results demonstrate that ZOL could exert an antiangiogenic effect in early prostate cancer through CEP and CEC modulation

EVIDENCIA Y SUBJETIVIDAD EN LAS INVESTIGACIONES LÓGICAS DE EDMUND HUSSERL

Se puede considerar un doble aspecto en las Investigaciones lógicas de Husserl:por una parte, es una obra madura; por otra parte, está concebida como obrapreparatoria de una tarea por realizar. El tema que nos ocupa, la evidencia, es elproblema central de la fenomenología, como lo ha reconocido Husserl mismo envarias ocasiones. El problema de la idealidad de la verdad, inseparable delconcepto de evidencia, conduce a la vez a una reflexión sobre la subjetividad. Enlo que sigue, trataremos sobre la evidencia adecuada y la evidencia apodíctica,con base en la distinción establecida por Husserl. Recogemos críticas a la nociónde apodicticidad tal como ella se encuentra en las Investigaciones lógicas, yseñalamos textos posteriores a dicha obra, en los cuales Husserl es más precisorespecto a su teoría de la evidencia

Hemorrhage-Adjusted Iron Requirements, Hematinics and Hepcidin Define Hereditary Hemorrhagic Telangiectasia as a Model of Hemorrhagic Iron Deficiency

BACKGROUND: Iron deficiency anemia remains a major global health problem. Higher iron demands provide the potential for a targeted preventative approach before anemia develops. The primary study objective was to develop and validate a metric that stratifies recommended dietary iron intake to compensate for patient-specific non-menstrual hemorrhagic losses. The secondary objective was to examine whether iron deficiency can be attributed to under-replacement of epistaxis (nosebleed) hemorrhagic iron losses in hereditary hemorrhagic telangiectasia (HHT). METHODOLOGY/PRINCIPAL FINDINGS: The hemorrhage adjusted iron requirement (HAIR) sums the recommended dietary allowance, and iron required to replace additional quantified hemorrhagic losses, based on the pre-menopausal increment to compensate for menstrual losses (formula provided). In a study population of 50 HHT patients completing concurrent dietary and nosebleed questionnaires, 43/50 (86%) met their recommended dietary allowance, but only 10/50 (20%) met their HAIR. Higher HAIR was a powerful predictor of lower hemoglobin (p = 0.009), lower mean corpuscular hemoglobin content (p<0.001), lower log-transformed serum iron (p = 0.009), and higher log-transformed red cell distribution width (p<0.001). There was no evidence of generalised abnormalities in iron handling Ferritin and ferritin(2) explained 60% of the hepcidin variance (p<0.001), and the mean hepcidinferritin ratio was similar to reported controls. Iron supplement use increased the proportion of individuals meeting their HAIR, and blunted associations between HAIR and hematinic indices. Once adjusted for supplement use however, reciprocal relationships between HAIR and hemoglobin/serum iron persisted. Of 568 individuals using iron tablets, most reported problems completing the course. For patients with hereditary hemorrhagic telangiectasia, persistent anemia was reported three-times more frequently if iron tablets caused diarrhea or needed to be stopped. CONCLUSIONS/SIGNIFICANCE: HAIR values, providing an indication of individuals' iron requirements, may be a useful tool in prevention, assessment and management of iron deficiency. Iron deficiency in HHT can be explained by under-replacement of nosebleed hemorrhagic iron losses

Can iron treatments aggravate epistaxis in some patients with hereditary hemorrhagic telangiectasia?

Objectives/Hypothesis To examine whether there is a rationale for iron treatments precipitating nosebleeds (epistaxis) in a subgroup of patients with hereditary hemorrhagic telangiectasia (HHT). Study Design Survey evaluation of HHT patients, and a randomized control trial in healthy volunteers. Methods Nosebleed severity in response to iron treatments and standard investigations were evaluated by unbiased surveys in patients with HHT. Serial blood samples from a randomized controlled trial of 18 healthy volunteers were used to examine responses to a single iron tablet (ferrous sulfate, 200 mg). Results Iron tablet users were more likely to have daily nosebleeds than non–iron-users as adults, but there was no difference in the proportions reporting childhood or trauma-induced nosebleeds. Although iron and blood transfusions were commonly reported to improve nosebleeds, 35 of 732 (4.8%) iron tablet users, in addition to 17 of 261 (6.5%) iron infusion users, reported that their nosebleeds were exacerbated by the respective treatments. These rates were significantly higher than those reported for control investigations. Serum iron rose sharply in four of the volunteers ingesting ferrous sulfate (by 19.3–33.1 μmol/L in 2 hours), but not in 12 dietary controls (2-hour iron increment ranged from −2.2 to +5.0 μmol/L). High iron absorbers demonstrated greater increments in serum ferritin at 48 hours, but transient rises in circulating endothelial cells, an accepted marker of endothelial damage. Conclusions Iron supplementation is essential to treat or prevent iron deficiency, particularly in patients with pathological hemorrhagic iron losses. However, in a small subgroup of individuals, rapid changes in serum iron may provoke endothelial changes and hemorrhage