La demande d’information des patientes, de la nécessité de mettre en doute nos pratiques: Réflexion à partir de la macrobiopsie mammaire sous IRM

Inform the patient is an obligation. The law request to inform on a number of points clearly defined in the Article L1111-2 of the code de la santé publique, however, it seems necessary to question our practices about the patient’s request of information. Indeed, medical information seems unavoidable but should it be the only concern of the caregiver?The objective of this study is to define more precisely the patient’s demand of information undergoing breast biopsy under MRI.Materials and methods: The study is based on semi-structured interviews about twenty minutes of patients who underwent breast MRI biopsy on the centre de lutte contre le cancer René Huguenin (Saint-Cloud). The interviews focused on the experiences of the examination, determination of the information provided by caregivers, information personally sought by the patient and the information requested by the patient to caregivers.Results: The study included all patients (n = 6) who underwent the examination within a period of two months between April and May 2015. The results are interpreted from the themes of the interview grid.Discussion: the request for information of patients differs from the design that can be built from the Law of 4 March 2002. In addition, patients’ request for information is often subject to a need for humanity invites us to rethink our information rules. Doubt is a necessity if we want to be hampered in our reflections on the practice of medical information.Informer le patient est une obligation. La loi demande clairement d'informer sur un nombre de points bien défini dans l'article L1111-2 du code de la santé publique cependant il semble nécessaire de remettre en question nos pratiques en nous interrogeant sur la demande d'information des patients. En effet, L'information médicale semble incontournable mais cela doit-il être la seule préoccupation des soignants ? L'objectif de cette étude est de définir plus précisément la demande d'information de patientes devant subir une macrobiopsie mammaire sous IRM. Matériel et méthodes : l'étude est basée sur une étude bibliographique et sur les entretiens semi-directifs d'environ une vingtaine de minutes de patientes ayant subi une macrobiospie mammaire sous IRM au Centre de Lutte Contre le Cancer René Huguenin (Saint-Cloud). Les entretiens portaient sur le vécu de l'examen, la détermination de l'information donnée par les soignants, l'information recherchée personnellement par la patiente et l'information demandée par la patiente aux soignants. Résultats : L'étude a inclus toutes les patientes (n=6) ayant subi l'examen dans un laps de temps de deux mois entre avril et mai 2015. Les résultats sont interprétés à partir des thématiques de la grille d'entretien. Discussion : la demande d'information des patientes diverge de la conception que l'on peut se construire à partir de la loi du 4 mars 2002. De plus, la demande d'information des patientes est souvent subordonnée à un besoin d'humanité qui nous invite à repenser nos modalités d'information. Le doute est une nécessité si nous ne voulons être entravés dans nos réflexions sur la pratique de l'information médicale. Abstract : Inform the patient is an obligation

Perceptions of artificial intelligence in healthcare: findings from a qualitative survey study among actors in France

International audienceBackground: Artificial intelligence (AI), with its seemingly limitless power, holds the promise to truly revolutionize patient healthcare. However, the discourse carried out in public does not always correlate with the actual impact. Thus, we aimed to obtain both an overview of how French health professionals perceive the arrival of AI in daily practice and the perception of the other actors involved in AI to have an overall understanding of this issue.Methods: Forty French stakeholders with diverse backgrounds were interviewed in Paris between October 2017 and June 2018 and their contributions analyzed using the grounded theory method (GTM).Results: The interviews showed that the various actors involved all see AI as a myth to be debunked. However, their views differed. French healthcare professionals, who are strategically placed in the adoption of AI tools, were focused on providing the best and safest care for their patients. Contrary to popular belief, they are not always seeing the use of these tools in their practice. For healthcare industrial partners, AI is a true breakthrough but legal difficulties to access individual health data could hamper its development. Institutional players are aware that they will have to play a significant role concerning the regulation of the use of these tools. From an external point of view, individuals without a conflict of interest have significant concerns about the sustainability of the balance between health, social justice, and freedom. Health researchers specialized in AI have a more pragmatic point of view and hope for a better transition from research to practice.Conclusion: Although some hyperbole has taken over the discourse on AI in healthcare, diverse opinions and points of view have emerged among French stakeholders. The development of AI tools in healthcare will be satisfactory for everyone only by initiating a collaborative effort between all those involved. It is thus time to also consider the opinion of patients and, together, address the remaining questions, such as that of responsibility

Plaidoyer pour un enseignement de l’éthique plus approfondi dans la formation initiale de manipulateur en électroradiologie médicale. Mise au point sur la formation de manipulateur en électroradiologie médicale

The medical radiation technologist is a health professional very specific. He is a technician in charge of high technology material potentially dangerous and/or radiant. But he is above all else a career charged with the same legal and ethical responsibilities as the other medical and paramedical staff. This article deals with the genesis of the profession of medical radiation technologist, with the legal regulations which surrounds it and with the formation of this “technician career”Le manipulateur d’électroradiologie médicale est un professionnel de santé très spécifique. C’est un technicien chargé d’utiliser du matériel médical de haute technologie potentiellement dangereux et/ou irradiant mais c’est avant tout un soignant chargé des mêmes responsabilités légales et éthiques que tout autre personnel médical et paramédical. Cet article traite de la genèse du métier de manipulateur d’électroradiologie médicale, des règles légales qui l’encadre et de la formation de ce « technicien soignant »

How to change West-African minds in order to increase general acceptation of autopsies?

No Abstract

[Living kidney donation].

International audienceOBJECTIVES:To review ethical, legal and technical aspects of living kidney donor surgery.MATERIAL AND METHODS:An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords: Donor nephrectomy; Kidney paired donation; Kidney transplantation; Laparoscopic nephrectomy; Living donor; Organs trafficking; Robotic assisted nephrectomy; Vaginal extraction. French legal documents have been reviewed using the government portal (http://www.legifrance.gouv.fr). Articles were selected according to methods, language of publication and relevance. A total of 6421 articles were identified; after careful selection, 161 publications were considered of interest and were eligible for our review.RESULTS:The ethical debate focuses on organ shortage, financial incentive, organ trafficking and the recent data suggesting a small but significant increase risk for late renal disease in donor population. Legal decisions aim to increase the number of kidneys available for donation, such as kidney-paired donation that faces several obstacles in France. Laparoscopic approach became widely used, while robotic-assisted donor nephrectomy failed to demonstrate improved outcome as compared with other minimal invasive techniques.CONCLUSION:Minimally invasive living donor nephrectomy aims to limit side effects in the donor without increasing the morbidity in this specific population of healthy persons; long term surveillance to prevent the onset of renal disease in mandatory

Validating a blood donation awareness tool created using general practitioner and patient acceptability and preferences

International audienceBACKGROUND: There is a need to develop an awareness raising tool for GPs to reach out their patients in order to increase blood donation. The main objective was to create and validate a tool to raise awareness about blood donation that meets acceptability and preference criteria and is applicable in general practice. MATERIAL AND METHODS: This cross-sectional study was conducted in three phases. 1. Tool creation: A stakeholder meeting co-developed three potential tools to raise awareness about blood donation: a consulting room poster, a waiting room poster and a lapel badge for the doctor. Three GPs pilot-tested each tool for one day during their regular consultations. Then, once the pilot was completed each GP assessed acceptability and preference using a semi-structured interview, and patients were also interviewed. 2. Consensual tool selection: An appropriate tool was selected based on pilot data using nominal group technique and expert review. 3. The tool was validated for its acceptability in practice via a quantitative questionnaire distributed electronically to GPs. RESULTS: The consensual tool selected by the nominal group was a combination of elements from all three tools trialled in the pilot, reported to be non-intrusive and convenient for both GPs and patients. Patient responses indicated a high level of acceptability and indicated a strong preference for self-generated discussion of the topic with their GP. In the validation step, 217 responses to the quantitative questionnaire were received: 74.5% of responses fulfilled the acceptability criteria for using this combined tool in general practice. Furthermore, 93.1% of GPs indicated they would use the tool in the proposed format for the purpose of raising awareness. DISCUSSION: The validation of our blood donation awareness tool for use in general practice justifies its evaluation on a larger scale as part of a wider blood donation awareness campaign