Un service d'urgence en psychiatrie : quelle interface pour l'accès aux soins ?: Etude statistique de l'activité d'un service d'urgence de 1999 à 2003

Article en ligne : http://www.john-libbey-eurotext.fr/en/revues/medecine/ipe/e-docs/00/04/21/59/article.phtmlInternational audienceEmergency psychiatric services: what interface is needed to access care? Statistical study into the activities of an emergency ward from 1999 to 2003.Emergency reception is a core issue in the question of access to psychiatric care. Reception facilities are not restricted to an institution, but are rather an interface between the various types of demand and the array of possible courses of treatment in psychiatry. At the specialised hospital at Saint-Jean-de-Dieu in Lyon, the emergency ward and department for medical information inventoried arrivals in their emergency reception over a period of 5 years (1999-2003) asking doctors to fill in a form giving precise details on the profile of patients dealt with. The data compiled represents 14,689 emergency situations corresponding to 6,568 patients. Different patient profiles were established revealing differing demands on emergency care. In emergency reception a crisis reception service and chronicity reception service coexist. Emergency reception is a crucial interface for patients of the first category (crisis profile) to access care, but a “substitute” structure for the second group (chronic). This raises the idea of creating reception areas specifically directed at chronic mental distress.L'accueil des urgences est au cœur de la problématique de l'accès aux soins en psychiatrie. Loin d'être exclusivement un lieu de soin institutionnel, il se présente comme une interface entre une demande multiforme de prise en charge et la multiplicité des parcours de soin en psychiatrie. Au CHS Saint-Jean-de-Dieu à Lyon, le service des urgences et le DIM ont recensé, pendant 5 ans (de 1999 à 2003), les passages dans l'UAU de leur établissement grâce à une fiche remplie par les médecins et renseignant de façon précise le profil des patients reçus en urgence. Les données collectées représentent 14 689 situations d'urgences correspondant à 6 568 patients. Différents profils de patients ont pu être établis et amènent à constater une consommation différenciée de l'urgence. À l'UAU cohabitent un accueil de la crise et un accueil de la chronicité. L'urgence est une interface indispensable pour l'accès aux soins pour les patients de la première catégorie (profil de crise) mais une structure de « substitution » pour la deuxième population (chroniques). Cela amène à penser la création de lieux d'accueil spécifiques de la détresse psychique chroniqu

Les Fugues des patients hospitalisés en service de psychiatrie (étude statistique et approche clinique)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La Réparation du psychotraumatisme chez les victimes d'accident du travail

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La Violence dans l'hôpital psychiatrique

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La Réparation du psychotraumatisme chez les victimes d'accident du travail

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

[Conversion disorder in the elderly]

International audienceThe dismemberment of the concept of neurosis, particularly of hysteria, in the current classifications (DSM-III and following, ICD-10) has led the authors to consider the concept of somatisation and the various situations included in it. Somatic disorders as the manifestation of a mental disorder, often of a depressive or anxious nature, bring back to the forefront both hysteria and its semiological forms under the global term "somatoform disorders", and in parallel with new pathologies, somatic symptoms as specific behaviors associated with the representation of a morbid condition from the point of view of an inhabitual physical perception. The expression of the psychic apparatus into the body, and its various clinical manifestations, has no direct specificity in the elderly. However, it is both frequent, and frequently misunderstood, thus requiring particular vigilance from the physician when confronted with physical complaints among elderly patients in whom the link between the body and the psychic apparatus takes on a particular role with the approach of death and the bereavement process that it requires. A structural approach, and search for event-driven factors and psychodynamic elements should be the key points of the clinician's approach

Impact of EBM Fabrication Strategies on Geometry and Mechanical Properties of Titanium Cellular Structures

International audienceManufacturing well controlled cellular materials by conventional methods is strongly difficult 2 (foaming, replication...). Additive Manufacturing appears to be a promising answer for such structures. The EBM technology is indeed theoretically able to produce freeform metallic open cell materials or lattice structures 3. However, due to the process, differences in strut geometries are observed between the CAD model and the manufactured parts, which affect mechanical properties. This study is focused on the determination and improvement of parameters which tailor the mesostructure of titanium cellular structures made by EBM. Mechanical properties are determined by compressive tests on various cellular structures (Cubic, Octet-truss...). Results indicate that the desired relative density (as defined by the CAD model) is not relevant for giving a correct estimation of the mechanical properties. Different sizes, shapes and orientations of struts have been quantitatively studied using X-Ray tomography. Geometry and residual porosity are analysed. An effective cross-section is defined and compared to the desired one. This effective cross-section is strongly related to the strut orientations and fabrication strategies. It allows to explain discrepancies in mechanical properties (stiffness and strength) between desired and real structures. The comparison with tomography results shows the necessity to adapt Gibson and Ashby's laws4 for the mechanical properties prediction of cellular solids made by EBM

L'identité du psychothérapeute / Paul Gerin, Jean-Pierre Vignat ; avant-propos de Daniel Widlöcher

Collection : Psychiatrie ouverte ; 10Contient une table des matièresAvec mode text

Mechanical equivalent diameter of single struts for the stiffness prediction of lattice structures produced by Electron Beam Melting

International audienceThe Electron Beam Melting (EBM) technology enables the manufacturing of new designs and sophisticated geometries. The process is particularly well suited for the fabrication of lattice structures. A standard methodology is presented in order to predict the mechanical response of lattice structures fabricated by EBM. The inner and outer structure of single struts produced by EBM was characterized using X-ray tomography. Struts with a 1 mm diameter and different orientations respect to the build direction were analyzed. The geometry discrepancies between the designed and the fabricated strut were highlighted. Two effects were identified. (i): The produced struts are generally thinner than the designed ones. (ii): Within the produced struts, loads are not transmitted by the entire geometry. It was therefore suggested to separate the strut between the mechanically âefficient and inefficientâ? matter. The elastic response of the strut was assumed to be represented by a circular cylinder with an equivalent diameter. Two equivalent diameters were defined. The first one is the diameter of an inscribed cylinder whereas the second one is the result of a numerical simulation based on the 3D image of the strut characterized by X-ray tomography. The methodology was then applied to an octet-truss lattice structure. The difference in terms of Young's modulus between both approaches and experimental values were discussed. The mechanical equivalent diameter obtained by numerical simulation on a 3D image of the strut allows to simulate the âtrueâ? properties of the lattice structure by taking into account the manufacturing constraints of the EBM process

Design Rules for Additive Manufacturing of Titanium Cellular Structures by Electron Beam Melting

International audienceAdditive Manufacturing (or Rapid Prototyping) underwent an increase of interest these past decades for the fabrication of plastic prototypes. More recently, the possibility of creating metallic parts from 3D models made possible the manufacturing of new designed metallic parts1. The Electron Beam Melting (EBM) technology can produce metallic parts by selectively melting a powder's bed layer by layer with an electron beam. Manufacturing cellular materials, which is strongly difficult by conventional methods2, become elementary by additive manufacturing. The EBM technology is indeed theoretically able to produce freeform metallic foams3. Due to the process, differences in struts sizes could be observed between CAD model and the manufactured part which leads to a lower mechanical resistance. This study is focused on the determination and improvement of parameters which tailor the geometry and surface quality of titanium foams made by EBM. Different size, shape and orientations of struts (from 50µm to 3mm of diameter, circle section or squared section and horizontally or vertically-produced) have been studied by high resolution X-Ray tomography and image analysis to access to their inner properties. Their geometry, surface roughness and pore content are analysed. The area of the real cross-section (represented as an inscribed ellipse) is compared to the desired one for the prediction of the mechanical resistance and the minimum strut size allowing the desired mechanical strength. The compressive tests on foams gives a comparison with tomography results for the adaptation of Gibson and Ashby's laws4 for the mechanical resistance prediction of cellular solids made by EBM. Due to the process, it is no more possible to link directly the young's modulus with the density, so that a correction factor is created to take into account the difference between outer size and real inner cross-section