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

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

TripAdvisor of healthcare: Opportunities for value creation through patient feedback platforms

The objective of this study is to explore new opportunities for hospitals to use patient feedback platforms (i.e., digital platforms on which patients express their opinions on their care journeys). Patient feedback platforms generate an ever-expanding amount of data on patient experience of care that is currently unused by most hospital or their business intelligence unit. We used the methodological approach of netnography on the negative feedback received by one hospital combined with interviews to identify the potential value of the data generated by the patient feedback platform. The main findings are that a digital feedback platform serves as a source of data to indicate: (1)Where to act (by localizing the negative comments), (2) On what to act (what thematic provides satisfaction and therefore is to be kept; or causes dissatisfaction and thus is to be improved), and (3) How to innovate (ideas about new practices to implement). It becomes evident that the platforms are developing a service to help hospitals make sense of this raw data and that a hospital can use patient feedback from other hospitals to improve their own practices. The first implication of our results is that patient feedback platforms generate a complementary type of feedback (i.e. based on patient perception and not empirical fact), as well as a source of data (i.e., patients’ external spontaneous feedback and not internally controlled survey feedback) for the Business Intelligence unit engaged in the transformation of the hospital towards patient-centered care. The second implication is that these platforms create a feedback network effect (i.e. A patient’s feedback can be used by hospitals other than the focal hospital concerned by that feedback, therefore increasing the overall value of the platform). The third implication is that digital transformation is enabled not only by data generation on the platform but also by data analysis services provided by the third party that runs the platform

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

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

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

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

Full Scale Field Test on a Slope Progressive Failure

In order to obtain the mechanical behaviour parameters of the red structured clays from the Danube- Black Sea Canal and to estimate the behavior of the slopes cut in such clays, an experimental programme was carried out. A checked failure was provoked for a slope dug in red fissured clays. The paper presents the results of the field investigations and the laboratory test regarding the, characteristics of the structured clays, as well as the in situ measurements during the experimental programme. The results of these measurements are compared with those obtained by numerical symulation using a computer program