PRESSIONS ET BUDGET: UNE ETUDE QUALITATIVE DANS LE SECTEUR HOSPITALIER

International audienceThe Reliance on Accounting Performance Measures concept (RAPM) was the object of numerous criticisms for a decade. Criticisms concern in particular the weakness of the theories which the RAPM is based on. The measurement of this paradigm was criticized; the main attention was to know if the study measured the same concept. Few qualitative researches were conducted to identify what the RAPM paradigm is. This exploratory study, based on 31 semi- directives interviews, try to identify what and how the RAPM appears and what kind on effects it produces on operational agent in public hospital.Le courant Reliance on Accounting Performance Measures (RAPM), a fait l'objet de nombreuses critiques depuis une décennie. Ces critiques ont porté notamment sur les faiblesses théoriques qui sous tendent les études réalisées ainsi que sur les outils utilisés pour mesurer ce concept. Peu de recherches qualitatives dans ce domaine ont été menées afin de mieux cerner ce concept. Ce travail exploratoire, réalisé à partir de 31 entretiens semidirectifs, tente de mieux comprendre ce concept ainsi que ses effets sur les professionnels du secteur hospitalier public

Diagnostic challenges and treatment difficulties in a patient with excoriated acne conglobata

Acne conglobata is a rare and severe form of acne vulgaris, characterized by the presence of comedones, papules, pustules, nodules and sometimes hematic or meliceric crusts. Acne excoriée is a form of self-inflicted skin condition in which the patient picks on imaginary or real acne lesions. We report the case of a 16 year old Caucasian female patient from the urban area who addressed our dermatology department for erythematous, edematous plaques covered by pustules and crusts, located on the face. The anamnesis revealed that during the last weeks she had had a depressive mood after ending a relationship with her boyfriend and started scratching and picking on the lesions. The patient\u27s depressive mood prior to the worsening of the disease was probably aggravated by the condition. This might have determined the picking of the skin which could have impeded the response to standard treatment. The self-excoriative behavior could also be regarded as an appeal for help

Adverse reactions of biological therapies in patients with psoriasis

Psoriasis is a chronic, immune-mediated disorder characterized by well demarcated, erythematous plaques covered by thick, silvery-white scales, most often located on the knees, elbows, sacral area and scalp. It has a significant impact on the patient\u27s quality of life. Biological therapies revolutionized the treatment of psoriasis vulgaris but there has been concern regarding the use of those agents due to severe adverse reactions reported in patients receiving TNF-α inhibitors for various inflammatory diseases. The aim of this paper is to review the most important adverse reactions reported in patients receiving biological treatments. The most common and severe side effects associated with biologicals are infections, cardiac adverse reactions, neurologic adverse reactions, lymphomas, non-melanoma skin cancers and hepatobiliary disease

Vulvodynia; an under-recognized disease

Vulvodynia is a chronic condition which affects an increasing number of women; it presents currently an incidence that is higher than had previously been estimated. Regarding pathogenesis, several (hormonal, infectious, inflammatory and psychological) factors have been proposed, but vulvodynia etiology remains still unclear. This disorder is a multifactorial condition with a significant impact on the patient’s quality of life, yet is difficult to diagnose (an under-estimated/ under-recognized affection). Certain medical investigations are required in order to exclude other diseases (the diagnosis of vulvodynia being one of exclusion), but anamnesis and physical examination are essential steps in the diagnosis. Although many therapies have been proposed, both pharmacological and non-pharmacological, a standardized therapy has not yet been established/ generally accepted. Accordingly, many therapeutic options have been studied with varying results. Vulvodynia remains a challenging disease and a multidisciplinary approach is needed to achieve satisfactory outcomes. Further studies are needed to completely understand its pathogenesis and to develop a standardized treatment

Therapeutic challenges in a case of psoriasis with nail onset

Nail psoriasis affects a large number of patients with psoriasis and has a major psychosocial impact. Furthermore, it may be regarded as a predictor of more severe forms of psoriasis and early sign of psoriatic arthritis. The clinical presentations vary depending on the structure affected (nail matrix or nail bed), the nail lesions may range from minor to severe, but they are not specific. Treatment is a challenge, in most cases the lesions being resistant to therapy. We present a rare case of psoriasis with nail onset in a 59-year-old woman. The nail involvement confined to the fingernails was severe, with significant impairment of the patient’s quality of life. Conventional therapies failed to improve the nail lesions, but a marked improvement was achieved under etanercept therapy

The current treatment of erectile dysfunction

Erectile dysfunction (ED) is the inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. It is the most frequent sexual dysfunction in elderly men and its prevalence increases with age. Ever since ED was recognized as a real health problem, several treatment options became available and some of them proved to be very efficient. PDE5 inhibitors are the mainstay treatment of ED. However, other treatment options such as intracorporal injections, surgery, vacuum devices and prosthesis are also available for patients who are unresponsive to PDE5 inhibitors. Since none of the treatment options available so far has proven ideal, research in the field of sexual medicine continues. The aim of this paper is to review the most advances in the treatment of ED

Seismic vulnerability assessment: Methodological elements and applications to the case of Romania

This paper is intended to present some studies undertaken in order to develop a seismic vulnerability estimation system to fit the needs of development of earthquake scenarios and of development of an integrated disaster risk management system for Romania. Methodological aspects are dealt with, in connection with the criteria of categorization of buildings, with the definition of parameters used for characterizing vulnerability, with the setting up of an inventory of buildings and with the calibration of parameters characterizing vulnerability. Action was initiated along the coordinates referred to in connection with the methodological aspects mentioned above. The approach was made, as far as possible, specific to the conditions of Romania. Some data on results obtained to date are presented.seismic vulnerability, vulnerability estimation, earthquake scenarios, categorization of buildings, inventory of buildings, expected earthquake impact

Methylation landscape in the genome of higher plants of agronomical interest

In eukaryotic cells the methylation of cytosines in DNA is an essential mechanism which is implied in the dynamic organization of the genome structure, in relation to genes expression. Plant genomes contain a significant proportion and variable according to the species, of sequences which are likely to be methylated during the life of the plant. It is known that the establishment and the maintenance of methylation profiles in both genomic areas and specific sequences constitute a crucial mediator in the modulation of genes expression during development. Recent studies have evidenced the implication of epimutations in the adaptation of plants to their environment particularly in response to biotic and abiotic stresses. Recently, the complete mapping of methylation in the genomes of Arabidopsis thaliana and rice provided invaluable information on the distribution of methylation within genes in relation to their expression. The impact of changes in the methylation profiles on the characters of agronomic importance has not been intensively studied yet, whereas this question takes a considerable importance in the context of an increasing food demand and foreseen global climate changes. The METHYLANDSCAPE project proposes to isolate genomic DNA sequences on the basis of their degree of methylation and to connect the variation of their methylation profiles with, on the one hand, the expression of the corresponding genes and, on the other hand, with environmental or developmental processes. Thus, it should be possible to identify genes which expression is differentially controlled by methylation during development and/or in situation of stress, and likely to have an influence on the agronomic value of the plant. The METHYLANDSCAPE partners thus propose to bring signification advances in plant genomics on four original species, by integrating DNA methylation mapping and the relationship between epigenome and transcriptome, up to the generation of methylation-sensitive markers linked with characters of agronomic importance. (Texte intégral

On perturbations of Dirac operators with variable magnetic field of constant direction

We carry out the spectral analysis of matrix valued perturbations of 3-dimensional Dirac operators with variable magnetic field of constant direction. Under suitable assumptions on the magnetic field and on the pertubations, we obtain a limiting absorption principle, we prove the absence of singular continuous spectrum in certain intervals and state properties of the point spectrum. Various situations, for example when the magnetic field is constant, periodic or diverging at infinity, are covered. The importance of an internal-type operator (a 2-dimensional Dirac operator) is also revealed in our study. The proofs rely on commutator methods.Comment: 12 page