L’expérience vécue à domicile par les conjointes de partenaires atteints de la démence de type Alzheimer au moment des soins d’hygiène

Suite à une recension des écrits sur les soins d’hygiène des personnes atteintes de démence de type Alzheimer (DTA), force est de constater la rareté, voire l’absence de recherches sur la question des soins d’hygiène (SH) dispensés à domicile par les conjointes. Pourtant, la conjointe à domicile est confrontée aux mêmes difficultés que les intervenants des établissements de santé et doit ainsi faire face aux comportements, parfois difficiles de la personne atteinte. Dans la pratique, les infirmières questionnent peu les difficultés rencontrées par les aidantes au moment des soins d’hygiène, ce qui permet difficilement de prendre conscience de leurs sentiments d’isolement et de détresse et de les réduire, le cas échéant. Pour pallier cette lacune, la présente recherche vise à comprendre l’expérience que vivent des conjointes d’hommes atteints de DTA lorsqu’elles leur dispensent des SH à domicile. Un second objectif vise à identifier les dimensions qui sont associées à cette expérience. Une approche de recherche qualitative est utilisée. Les participantes ont été recrutées par l’entremise des Sociétés Alzheimer de Laval et des Laurentides. La stratégie de collecte des données a impliqué la réalisation de deux entrevues individuelles, face à face, de même que l’administration d’un court questionnaire portant sur les aspects sociodémographiques. La démarche retenue pour l’analyse de l’ensemble de données est inspirée de l’approche proposée par Miles et Huberman (2003). Les résultats permettent d’abord de mettre en évidence des profils de conjointes qui, tout en étant variables, présentent certaines similarités. Eu égard aux SH, toutes ont à consacrer des efforts soutenus, quotidiens et intenses. Elles doivent faire montre de patience et compter sur des capacités personnelles les amenant à ressentir des sentiments positifs malgré les situations difficiles. Les résultats montrent par ailleurs que la dispensation des SH provoque aussi des sentiments négatifs associés au fardeau que ces soins impliquent. Les conjointes mettent toutefois en œuvre une variété de stratégies d’adaptation au stress telles la résolution de problème, la recherche de soutien social et le recadrage. Cinq ensembles de dimensions personnelles et contextuelles sont associés à l’expérience des aidantes : 1) En ce qui a trait aux caractéristiques personnelles des conjointes, l’avancement en âge et l’état de santé physique ou psychologique influencent négativement l’expérience lors des SH. Par contre, les ressources personnelles intrinsèques (acceptation de la réalité, capacité de trouver un sens à l’évènement, habileté à improviser et sens de l’humour) sont utilisées de manière naturelle ou acquise; 2) Les caractéristiques personnelles du conjoint (année du diagnostic, pertes d’autonomie et troubles de comportement) affectent négativement l’expérience vécue; 3) La relation conjugale présente un intérêt important puisqu’il apparaît qu’une relation conjugale pré-diagnostic positive semble favoriser des sentiments positifs chez la conjointe en ce qui a trait aux SH; 4) Les dimensions familiales ont un impact favorable, étant donné le soutien psychologique reçu de la famille; 5) Les dimensions macro-environnementales, incluant l’aide reçue du réseau informel plus large de même que du réseau formel, ainsi que les divers aménagements matériels de l’environnement physique du couple, ressortent enfin comme ayant un impact positif. Au terme de l’analyse des résultats, l’auteure est en mesure de proposer une synthèse de l’expérience des conjointes. La discussion aborde quatre enjeux qui se dégagent des résultats observés : impacts des difficultés rencontrées lors des SH dans la décision d’hébergement, réticence des aidantes à faire appel aux ressources du réseau formel pour obtenir de l’aide eu égard aux SH, importance des ressources personnelles des aidantes et potentiel de l’approche relationnelle humaine (human caring) pour faire face aux défis que pose la dispensation des SH.Following a review of the literature on hygiene care practices for patients with Alzheimer-type dementia (DAT), there is no choice but to accept the scarcity, even absence of research on the question of hygiene care (HC) dispensed at home by female partners. Nevertheless, the female partner at home is faced with the same problems as workers in health care institutions, and so must cope with the sometimes-difficult behaviours of their partner afflicted with dementia. In practice, nurses ask very little about the difficulties caregivers encounter when providing hygiene care, and this does nothing to lessen the feelings of isolation and distress. To fill this gap, the present research seeks to understand what the female partners of men with DAT experience when they provide them with HC at home. A second objective is aimed at identifying the dimensions associated with this same experience. A qualitative research approach is used. Participants were recruited through the Alzheimer Societies of Laval and the Laurentides. The strategy for data collection involved conducting two individual, face-to-face interviews, as well as administering a short questionnaire about the sociodemographic aspects. The approach used for analyzing all the data was based on the approach proposed by Miles and Huberman (2003). In the first instance, the outcomes reveal the profiles of the female partners, which, while variable, present certain similarities. With regard to HC, all have to make sustained, concentrated efforts daily. They must have energy and patience, and rely on personal capacities to maintain positive feelings despite the difficult situations. The outcomes also show that dispensing HC also provokes negative feelings associated with the burden that this type of care brings with it. Nevertheless, female partners implement a variety of strategies to adapt to the stress, such as problem solving, seeking social support and refocusing/reorientation. Five sets of personal and contextual dimensions are associated with the caregiver experience: 1) With respect to the personal characteristics of the female partner, advanced age and the state of physical or psychological health have a negative influence on the HC experience. On the other hand, inherent personal resources (acceptance of the reality, capacity to find meaning in what has happened, ability to improvise and sense of humour) are used either natural or learned; 2) The personal characteristics of the male partner (year of diagnosis, loss of autonomy and behaviour problems) negatively affect the experience; 3) The marital relationship is also of great interest as it appears that a positive pre-diagnosis marital relationship seems to favour positive feelings in the female partner with respect to HC ; 4) The familial dimensions have a favourable impact, with regard to the psychological support received from the family; 5) Finally, the macro-environmental dimensions, including help received from both the wider informal, and the formal network, as well as the various material accommodations in the couple’s physical environment, emerge as having a positive impact. At the conclusion of the outcome analysis, the author is able to offer a summary of what the couple’s experience. The discussion involves four issues that emerge from the outcomes observed: impacts of the difficulties encountered during HC on the decision for selecting accommodation, reticence of caregivers to make recourse to resources in the formal network for help with HC, importance of the personal resources of the caregivers, and the potential of the human caring approach in dealing with the challenges arising in the dispensing of HC

Potential changes to French recommendations about peri-prosthetic infections based on the international consensus meeting (ICMPJI)

AbstractBackgroundDespite the large volume of studies on the prevention, diagnosis, and treatment of peri-prosthetic infections, surgical practice often rests on limited scientific evidence in this field. The vast International Consensus Meeting on Peri-prosthetic Joint Infection (ICMPJI) held in 2013 produced robust recommendations.HypothesisFrench consensus conference recommendations show no major differences with ICMPJI recommendations.Materials and methodsThe 207 recommendations developed by 300 experts at the ICMPJI were translated, and the translation was then examined by four reviewers, including 2 having participated in the consensus conference. The reviewers looked for any differences with French practices and recommendations.ResultsTwenty-three major differences or innovations were identified compared to French recommendations and standard practice. Among them, pre-operative screening for nasal or urinary micro-organisms is performed routinely in France but should be reserved according to the ICMPJI for symptomatic patients and/or patients at high risk for infection. The ICMPJI emphasizes the role for the operating room environment as a vector for infection; more specifically, the operating lamp handle and suction cannula deserve close attention. A wound discharge persisting longer than 5–7 days requires irrigation and debridement. This procedure is effective only within the first 3 post-operative months and/or the first 3 weeks after symptom onset and must include exchange of all modular implants. The ICMPJI warns against both irrigation-debridement in fungal infections (suggesting two-stage prosthesis replacement) and one-stage replacement in patients with sinus tracts. The use of spacers (articulating at the knee) is recommended in the event of two-stage prosthesis replacement.DiscussionThe ICMPJI recommendations differed in many ways with French recommendations and standard practice. They can be expected to impact practices in France, although a point worth noting is that only 1 of the 207 recommendations received unanimous agreement by the conference experts (keeping operating room traffic to a minimum)

Évaluation de la performance des ouvrages de gestion durable des eaux pluviales de la rue Sainte-Claire à Rivière-du-Loup

Les ouvrages de gestion durable des eaux pluviales (GDEP) situés sur la rue Sainte-Claire à Rivière-du-Loup, au Québec, sont étudiés selon trois volets : l'hydraulique, la qualité de l'eau et le complexe plantes/substrat. Des cellules de biorétention, du pavé perméable et des chambres souterraines de rétention constituent les ouvrages étudiés qui gèrent les eaux pluviales de la rue Sainte-Claire et de trois rues perpendiculaires. Des équipements ont été installés entre juin 2020 et octobre 2021 poursuivre l'écoulement des eaux à plusieurs endroits du site. Le pavé perméable et le bassin de rétention, en série permettent de retarder de cinq minutes à plus d'une heure le débit de pointe et de le réduire jusqu'à 90 % pour les événements enregistrés, dont la récurrence est inférieure ou égale à deux ans. Le taux d'infiltration des interstices du pavé perméable est très élevé, même en hiver, lorsqu'un entretien est réalisé, mais chute drastiquement sinon : il varie entre 29,6 et 0,3 x 10³ mm/h. Les matières en suspension (MES) subissent un enlèvement médian de 78 %, allant jusqu'à 98 %, entre le ruissellement et la sortie du bassin. Le pavé perméable seul permet un enlèvement moyen de 68 % des MES. La conductivité électrique des eaux à la sortie du bassin après la période hivernale est très élevée, jusqu'à 741 μS/cm. Les ouvrages de GDEP n'influencent pas significativement les teneurs en azote et en phosphore totaux. Les végétaux des biorétentions présentent un taux de survie de près de 100 % et une résistance à la sécheresse, le tout sans entretien sauf pour la coupe automnale des graminées. Des taux de croissance moyens de 50 à 150 %/mois, selon l'espèce, ont été mesurés entre juin et juillet 2021.Hydraulic, water quality, plant growth and substrate performance were studied for stormwater best management practices (BMP) installed in Rivière-du-Loup, Québec. They consist of bioretention cells, permeable pavement and underground basin which collect runoff water form Sainte-Claire Street as well as three other perpendicular streets. Water dynamic was monitored from June 2020 to October2021. Combined action of the permeable pavement and the retention basin reduced peak flow up to 90 % and delayed it from five minutes to more than an hour, for two years and less return period rainfalls. Surface infiltration rate of permeable pavement varies from 29.6 x 10³ (very high) to 0.3 x 10³ mm/h, depending on maintenance operations. Total suspended solids (TSS) were removed up to 98 % from runoff to the outfall, with a median value of 78 %. Average TSS removal for permeable pavement alone was 68 %. Electrical conductivity was very high in early spring, up to 741 μS/cm. BMP had no clear effect on total nitrogen and phosphorus content. Plant survival and drought resistance was high for plants located in retention cells, with minimal maintenance requirements

First Initial community-acquired meningitis due to extended-spectrum beta-lactamase producing Escherichia coli complicated with multiple aortic mycotic aneurysms

We report the first case of extended-spectrum beta-lactamase producing E. coli community-acquired meningitis complicated with multiple aortic mycotic aneurysms. Because of the acute aneurysm expansion with possible impending rupture on 2 abdominal CT scan, the patient underwent prompt vascular surgery and broad spectrum antibiotic therapy but he died of a hemorrhagic shock. Extended-spectrum beta-lactamase producing E. coli was identified from both blood and cerebrospinal fluid culture before vascular treatment. The present case report does not however change the guidelines of Gram negative bacteria meningitis in adults

A framework for continuous target tracking during MR-guided high intensity focused ultrasound thermal ablations in the abdomen

Scatterplot showing percentage changes in stroke volume index (ΔSVI, %) and functional hemodynamic markers, Stroke Volume Variation (SVV, %) Pulse Pressure Variation (PPV, %), with the three tested tidal volumes (V T ), 6, 12 and 18 ml/kg during intra-abdominal hypertension. Solid line shows regression line between variables. (PDF 56 kb

Multiple common garden experiments suggest lack of local adaptation in an invasive ornamental plant

Aims: Adaptive evolution along geographic gradients of climatic conditions is suggested to facilitate the spread of invasive plant species, leading to clinal variation among populations in the introduced range. We investigated whether adaptation to climate is also involved in the invasive spread of an ornamental shrub, Buddleja davidii, across western and central Europe. Material and Methods: We combined a common garden experiment, replicated in three climatically different central European regions, with reciprocal transplantation to quantify genetic differentiation in growth and reproductive traits of 20 invasive B. davidii populations. Additionally, we compared compensatory regrowth among populations after clipping of stems to simulate mechanical damage. Important findings: Our results do not provide evidence for clinal variation among invasive B. davidii populations: populations responded similarly to the different environments, and trait values were not correlated to climatic conditions or geographic coordinates of their home sites. Moreover, we did not detect differences in the compensatory ability of populations. We suppose that the invasive spread of B. davidii has been facilitated by phenotypic plasticity rather than by adaptation to climate, and that continent-wide shuffling of cultivars due to horticultural trade may have limited local adaptation so far