Coproduction patterns and service quality : the case of the companion animal veterinary consultation

Le but d’une consultation médicale est de guérir le patient ou pour le moins, de tout mettre en oeuvre afin d’y parvenir. Jusqu’au XXème siècle, le médecin décide de tout puisqu’il sait mieux que quiconque comment soigner et quels traitements administrer. Au XXème siècle, cette pouvoir absolu décline peu à peu. Lorsqu’elle est ignorée, la dualité entre le médecin, expert des maladies, et le patient, expert de sa propre condition de malade, émerge comme un frein à la production du service de soins. La notion d’alliance thérapeutique apparait.Les Sciences de gestion mettent aussi en avant cette collaboration client-fournisseur avec le Service Dominant Logic. La qualité de la relation semble déterminante pour susciter la participation du client.Or la relation médecin-patient se construit au cours d’un processus dynamique retracé dans le Guide Calgary-cambridge, LA référence mondiale en matière de communication santé. Ce Guide doit permettre une cocréation de valeur.Paradoxalement, d’après ce Guide, le patient, de même pour le support du service lorsqu’il est vivant (animal, enfant, personne sous tutelle), participent passivement à l’interaction et ne mobilisent aucune compétence particulière.Ainsi, au cours d’une interaction de service, les conditions qui génèrent la coproduction du service et la cocréation de valeur et donc les compétences mobilisées pour y parvenir sont peu décrites en sciences de gestion ou dans l’activité de soins. Afin de répondre à cette question, nous avons choisi d’étudier la consultation vétérinaire canine, activité économique florissante très peu abordée jusque là. De plus, cette relation triadique de service B to C, implique un lien d’attachement entre le client et le support du service.La relation de service étant un processus dynamique dans le temps, nous avons choisi de filmer des consultations et de les analyser ensuite de manière qualitative et semi-quantitative en s’aidant d’entretiens avec les personnes présentes lors de la consultation.The purpose of a medical consultation is to cure the patient or at least to do everything possible to achieve it. Until the twentieth century, the doctor decides everything since he knows better than anyone how to treat and which medicine to administer. Then this absolute power declines gradually. When ignored, the duality between the knowledge brought by the physician, an expert in diseases, and that brought by the patient, an expert in his own physical condition, emerges as a barrier to the service coproduction. As a result, the notion of therapeutic alliance arises.Management science also emphasizes client participation and client-provider collaboration through the Dominant Logic Service approach. Thus, the doctor-patient relationship is being built unsing a dynamic process outlined in the Calgary-Cambridge Guide.Paradoxically, according to this Guide, the patient passively participates to the interaction and do not mobilize any particular competence.Therefore, during a service encounter, what are the conditions that generate the service coproduction and therefore the competencies mobilized by each actor to achieve it?To answer this question, we decided to study the canine veterinary consultation, a flourishing economic activity that has been little discussed so far. Moreover, this triadic relationship of B to C service implies an attachment bound between the customer and the service support.Our research brings theoretical contributions, notably a typology of functional and dysfunctional triads, managerial contributions to veterinary clinics regarding their approach of the customer relationship, an adjustment of the reflerential of veterinary activities for the French veterinary schools, as well as methodological originalities by the use of video and triangulation of data analysis

Region of interest to investigate after learning the use of ornaments by Rey

International audienc

Region of interest to investigate after learning the use of ornaments by Rey

International audienc

Region of interest to investigate after learning the use of ornaments by Rey

International audienc

Region of interest to investigate after learning the use of ornaments by Rey

International audienc

Efficacy and Safety of 4.7 mg Deslorelin Acetate Implants in Suppressing Oestrus Cycle in Prepubertal Female Dogs

Our multicentric, masked, controlled and randomised study aimed to assess the efficacy and safety of Suprelorin® 4.7 mg (Virbac, Carros, France) regarding oestrus prevention in prepubertal intact bitches. Twelve- to eighteen-week-old females (n = 83) were allocated either a deslorelin implant (n = 62) or 0.9% sodium chloride (n = 21) group. Clinical assessment (heat signs), 17β oestradiol and progesterone assays, and vaginal cytology were performed at day (D)0, D7, D21, month (M)3 and M6 after product administration, and were then performed every other month until reaching puberty. Trained owners assessed heat signs between each veterinary visit. All bitches (n = 83) reached puberty before M30. Deslorelin significantly extended the median time to sexual maturity when compared to the control group (377 days versus 217 days after D0, p < 0.0001). Three females, implanted between 16 and 18 weeks of age, expressed an induced oestrus. Additional descriptive data, collected over a 24 month-period, showed functional reproductive abilities in both deslorelin (n = 52) and control (n = 21) groups once puberty was achieved. In conclusion, Suprelorin® 4.7 mg seems to be an effective and safe option for postponing the onset of oestrus when administered to prepubertal female dogs aged from 12 to 16 weeks

Implementation of optimized supportive care and hospital needs along the management of patients with advanced lung cancer

Background: Supportive care in cancer (SCC) have been recommended to be integrated in the management of patients with lung cancer all along the course of the disease. We took advantage of a pilot program of early implementation of optimized SCC, to report the feasibility such program in patients with advanced lung cancer, and correlate patient characteristics and outcomes with the actual use of optimized SCC.Methods: This study is a retrospective analysis of all consecutive patients with lung cancer treated at our center between 2012 and 2016. Optimized SCC included the intervention of a nurse for the home-hospital network coordination, as well as socio-aesthetics, psychomotricity, art-therapy, adapted physical activity, and also establishment of at-home hospitalization.Results: 309 patients were included. Median overall survival was 11.2 months. Unplanned hospitalizations occurred for 276 (89%) patients. The median duration of hospital stay was 19 days. Unplanned hospitalizations more frequently occurred within the first 3 months after the diagnosis of advanced cancer, and in the last 3 months before death. A short - less than 3 months - delay between diagnosis and unplanned hospitalization was associated with poor outcome. 272 (88%) patients received optimized SCC, within a median delay of 8 weeks after diagnosis. Intervention of the nurse for in- and out-patient network coordination was done for 143 (46%) patients, and at-home hospitalization was organized for 78 (25%) patients. The outcome of patients who received optimized SCC was numerically, but not significantly better (median overall survival of 11.8 vs. 6.9 months, p = 0.270).Conclusion: Our study provides landmark data to support an early integration of optimized SCC for patients with advanced lung cancer, that includes multimodal supportive care interventions along the course of the disease. This highlights the role of multidisciplinary teams to optimize the management of patients with advanced lung cancer

Olfactory rehabilitation : Benefits of a multi-professional care

Près d’un français sur cinq souffre de troubles de l’odorat (TO), ou dysosmie. Cette prévalence a augmenté depuis l’apparition de la COVID-19 dont la dysosmie est un symptôme très fréquent et possiblement persistant. Pourtant, la prise en soin des personnes dysosmiques reste insuffisante. Cet article ouvre des pistes pour développer les rééducations olfactives (RO) sur la base de protocoles déjà éprouvés, mais aussi pour améliorer l’accompagnement des patients dysosmiques. Pour cela, une stratégie de prise en charge pluri-professionnelle est préconisée, alliant l’intervention de scientifiques, de médecins (généralistes, ORL) et de professions paramédicales.publishe

Transfer of AlGaAs/GaAs crystalline Bragg mirror from a GaAs substrate to a fused silica substrate by direct bonding

International audienceDirect bonding has been a major key technology in many fields nowadays. From microelectronic to optoelectronic technologies, it became a technique used for mass production technology in many different applications. Direct bonding of silicon or silicon dioxide is now a well known process. In this article, we explore this technology through the transfer of III-V AlGaAs/GaAs crystalline multilayer from its native GaAs substrate upon a fused silica substrate (SiO2). The goal of this work is to explore the conception of crystalline Bragg mirrors with low mechanical loss and high optical quality for precision measurement applications.We present the main results obtained for each step of the transfer process. Various experiment such as AFM characterization have been performed on the wafers to probe surface quality. Chemical wet etching with different experimental conditions have been tested to remove the GaAs substrate. We discuss the main challenges of the process, especially the bonding of two rather different materials from the thermo-mechanic point of view. Focus is also made on the chemistry used in the wet etching part to have a selective etching between GaAs and AlGaAs

Transfer of AlGaAs/GaAs crystalline Bragg mirror from a GaAs substrate to a fused silica substrate by direct bonding

International audienceDirect bonding has been a major key technology in many fields nowadays. From microelectronic to optoelectronic technologies, it became a technique used for mass production technology in many different applications. Direct bonding of silicon or silicon dioxide is now a well known process. In this article, we explore this technology through the transfer of III-V AlGaAs/GaAs crystalline multilayer from its native GaAs substrate upon a fused silica substrate (SiO2). The goal of this work is to explore the conception of crystalline Bragg mirrors with low mechanical loss and high optical quality for precision measurement applications.We present the main results obtained for each step of the transfer process. Various experiment such as AFM characterization have been performed on the wafers to probe surface quality. Chemical wet etching with different experimental conditions have been tested to remove the GaAs substrate. We discuss the main challenges of the process, especially the bonding of two rather different materials from the thermo-mechanic point of view. Focus is also made on the chemistry used in the wet etching part to have a selective etching between GaAs and AlGaAs