Marcher un chemin de légitimité et de liberté : un itinéraire de renouvellement de pratique

RÉSUMÉ : Dès le début de cette recherche je souhaitais conscientiser mon expérience de vie et de formation, interroger ma pratique et articuler mon expérience intime et ma pratique de formatrice et d’accompagnement. J’avais comme postulat de départ que m’engager dans ce chemin de formation et de recherche avec une visée de renouvellement de pratique pouvait contribuer à me faire gagner en liberté et en légitimité. Cette recherche visait aussi de relever un défi de justice épistémique en redonnant à ma quête spirituelle ses lettres de noblesses parmi les autres voies de production de connaissances. Cette recherche s’est construite à partir d’un processus de recherche impliquée de type réflexif et narratif, réalisée radicalement à la première personne, selon une logique de recherche qualitative. La démarche de recherche qui a structuré l’ensemble de ce mémoire s’inscrit dans un paradigme compréhensif et interprétatif et elle a privilégié une approche narrative de type heuristique et d’inspiration phénoménologique. La production des données a été faite à l’aide d’un journal d’itinérance et de récits phénoménologiques, alors que leur interprétation a été réalisée selon la méthode d’analyse en mode écriture. Ce travail de recherche exploratoire m’a permis de m’immerger profondément dans mon parcours de formation et dans ma pratique de formation et d’accompagnement, en vue d’y puiser du sens, de la cohérence et des savoirs susceptibles de soutenir ma quête de légitimité et de liberté. L’ensemble de cette démarche de recherche-formation m’a permis de renouveler mes manières d’être en relation et ma pratique de formatrice et d’accompagnatrice. Le processus de cette recherche m’a permis de voir émerger des possibilités inédites de transformation personnelle, de renouvellement professionnel et d’engagement spirituel en contexte laïc. -- Mot(s) clé(s) en français : Liberté, Légitimité, Reliance, Rituel, Initiation, Réenchantement, Démarche heuristique, Formativité, Renouvellement de pratique. -- ABSTRACT : From the beginning of this research, I wanted to raise my awareness of both my life and training experience, question my practice and articulate my intimate experience with my accompaniment practice. My assumption was that engaging in this path of training and research with a practice renewal goal could help me gain more freedom and legitimacy. This research also aimed to take on a challenge of epistemic justice by giving back to my spiritual quest its nobility among the other ways of knowledge production. This research was built from a reflexive and narrative type of research process, carried out radically in the first person, based on a qualitative research logic. The research process that has structured this entire thesis is part of and comprehensive and interpretative paradigm and has focused on a heuristic type of narrative approach, phenomenology inspired. The data were produced using a research journal and phenomenological narratives, while their interpretation was done using the writing-based analysis method. This exploratory research work allowed me to immerse myself deeply into my training journey and my training and coaching practice, in order to find from it meaning, coherence and knowledge that could support my quest for legitimacy and freedom. This entire research-training process has enabled me to renew my ways of being in all my relations as well as my practice as a trainer and coach. The process of this research has allowed me to see new possibilities of personal transformation, professional renewal and spiritual commitment emerge in a secular context. -- Mot(s) clé(s) en anglais : Freedom, Legitimacy, Ritual, Initiation, Reenchantment, Heuristic Approach, Formativeness, Practice Renewal

Effect of Cryoanalgesia Combined with Intravenous Continuous Analgesia in Thoracotomy Patients

Fifty patients undergoing thoracotomy was studied to compare the effects of cryoanalgesia combined with intravenous continuous analgesia (IVCA). Patients were randomized into two groups: IVCA group and IVCA-cryo group. Subjective pain intensity was assessed on a visual analogue scale at rest (VAS-R) and during movement (VAS-M). Analgesic requirements were evaluated over the 7 days following surgery. Forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1) were measured before operation, on the 2nd and 7th postoperative days (POD). We interviewed patients by telephone to evaluate the prevalence of post-thoracotomy pain at the 1st, 3rd, and 6th months postoperatively. No significant differences were observed between the two groups with respect to postoperative pain, analgesic requirements, side effects, respiratory complications, or prevalence of post-thoracotomy pain. However, a significant increase in FVC and FEV1 was observed on the 7th POD in IVCAc-ryo group. The incidence of the post-thoracotomy pain at the 1st, 3rd, and 6th months postoperatively was 68, 60, and 44% in IVCA group, and 88, 68, and 28% in IVCA-cryo group, respectively. Our study showed that cryoanalgesia combined with IVCA effectively restore respiratory function on 7th POD, but that it was not effective at reducing the incidence of post-thoracotomy pain

The impact of polymorphic variations in the 5p15, 6p12, 6p21 and 15q25 loci on the risk and prognosis of Portuguese patients with non-small cell lung cancer

Polymorphic variants in the 5p15, 6p12, 6p21, and 15q25 loci were demonstrated to potentially contribute to lung cancer carcinogenesis. Therefore, this study was performed to assess the role of those variants in non-small cell lung cancer (NSCLC) risk and prognosis in a Portuguese population. MATERIALS AND METHODS: Blood from patients with NSCLC was prospectively collected. To perform an association study, DNA from these patients and healthy controls were genotyped for a panel of 19 SNPs using a Sequenom® MassARRAY platform. Kaplan-Meier curves were used to assess the overall survival (OS) and progression-free survival (PFS). RESULTS: One hundred and forty-four patients with NSCLC were successfully consecutively genotyped for the 19 SNPs. One SNP was associated with NSCLC risk: rs9295740 G/A. Two SNPs were associated with non-squamous histology: rs3024994 (VEGF intron 2) T/C and rs401681 C/T. Three SNPs were associated with response rate: rs3025035 (VEGF intron 7) C/T, rs833061 (VEGF -460) C/T and rs9295740 G/A. One SNP demonstrated an influence on PFS: rs401681 C/T at 5p15, p?=?0.021. Four SNPs demonstrated an influence on OS: rs2010963 (VEGF +405 G/C), p?=?0.042; rs3025010 (VEGF intron 5 C/T), p?=?0.047; rs401681 C/T at 5p15, p?=?0.046; and rs31489 C/A at 5p15, p?=?0.029. CONCLUSIONS: Our study suggests that SNPs in the 6p12, 6p21, and 5p15 loci may serve as risk, predictive and prognostic NSCLC biomarkers. In the future, SNPs identified in the genomes of patients may improve NSCLC screening strategies and therapeutic management as well.This project was supported by Programa Doutoral em Medicina e Oncologia Molecular, University of Porto, Porto, Portugal and University of Minho, Braga, Portugal. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Prognosis in advanced lung cancer - a prospective study of examining key clinicopathological factors

AbstractObjectivesIn patients with advanced incurable lung cancer deciding as to the most appropriate treatment (e.g. chemotherapy or supportive care only) is challenging. In such patients the TNM classification system has reached its ceiling therefore other factors are used to assess prognosis and as such, guide treatment. Performance status (PS), weight loss and inflammatory biomarkers (Glasgow Prognostic Score (mGPS)) predict survival in advanced lung cancer however these have not been compared. This study compares key prognostic factors in advanced lung cancer.Materials and methodsPatients with newly diagnosed advanced lung cancer were recruited and demographics, weight loss, other prognostic factors (mGPS, PS) were collected. Kaplan–Meier and Cox regression methods were used to compare these prognostic factors.Results390 patients with advanced incurable lung cancer were recruited; 341 were male, median age was 66 years (IQR 59–73) and patients had stage IV non-small cell (n=288) (73.8%) or extensive stage small cell lung cancer (n=102) (26.2%). The median survival was 7.8 months. On multivariate analysis only performance status (HR 1.74 CI 1.50–2.02) and mGPS (HR 1.67, CI 1.40–2.00) predicted survival (p<0.001). Survival at 3 months ranged from 99% (ECOG 0–1) to 74% (ECOG 2) and using mGPS, from 99% (mGPS0) to 71% (mGPS2). In combination, survival ranged from 99% (mGPS 0, ECOG 0–1) to 33% (mGPS2, ECOG 3).ConclusionPerformance status and the mGPS are superior prognostic factors in advanced lung cancer. In combination, these improved survival prediction compared with either alone

Progress in the management and outcome of small-cell lung cancer in a French region from 1981 to 1994

Recent analyses of series of small-cell lung cancer (SCLC) patients included in clinical trials have shown improved survival over time, but it has been impossible to determine whether this was due to selection biases, stage migration, or true therapeutic improvement. To determine if there has been a true improvement of survival over time, we reviewed the medical records of all consecutive patients diagnosed with SCLC between 1981 and 1994 in the Bas-Rhin in France. Among the 787 patients (median age 63), there was no significant period effect for sex, age, or stage. Staging work-ups became increasingly thorough (significant period effect). The mean number of investigations and of tumour sites detected correlated significantly. The chemotherapy rate increased (from 76.4% in 1981–1983 to 91.7% in 1993–1994, P = 10−5) and mediastinal irradiation decreased (to roughly 25% of patients after 1983). Median survival time increased for the overall population from 6.6 months in 1981–1983 to 11.3 months in 1993–1994 (P = 10−5), for patients with limited disease (LD) from 9.2 (P = 0.002) months to 14.0 months, and for those with extensive (ED) disease from 3.5 months to 9.6 months (P = 10−5). Significant independent prognostic factors were disease extent, clinical trial participation, period, type of chemotherapy, and mediastinal irradiation in LD. Survival time has truly improved as ‘state of the art' management of SCLC has changed. © 2001 Cancer Research Campaignhttp://www.bjcancer.co

The Utility of Exercise Testing in Patients with Lung Cancer

The harm associated with lung cancer treatment include perioperative morbidity and mortality and therapy-induced toxicities in various organs, including the heart and lungs. Optimal treatment therefore entails a need for risk assessment to weigh the probabilities of benefits versus harm. Exercise testing offers an opportunity to evaluate a patient's physical fitness/exercise capacity objectively. In lung cancer, it is most often used to risk-stratify patients undergoing evaluation for lung cancer resection. In recent years, its use outside this context has been described, including in nonsurgical candidates and lung cancer survivors. In this article we review the physiology of exercise testing and lung cancer. Then, we assess the utility of exercise testing in patients with lung cancer in four contexts (preoperative evaluation for lung cancer resection, after lung cancer resection, lung cancer prognosis, and assessment of efficiency of exercise training programs) after systematically identifying original studies involving the most common forms of exercise tests in this patient population: laboratory cardiopulmonary exercise testing and simple field testing with the 6-minute walk test, shuttle walk test, and/or stair-climbing test. Lastly, we propose a conceptual framework for risk assessment of patients with lung cancer who are being considered for therapy and identify areas for further studies in this patient population