[Optimizing the management of heart failure: structuring the care pathway]

The incidence of chronic heart failure continues to rise in Western countries, justifying the implementation of an optimized multidisciplinary organization based on medical and nursing convergence. Around the main heart failure, assistance and transplantation unit at Toulouse University Hospital, several structures have been put in place to better manage heart failure patients and improve their care pathway.

[Prehabilitation in chronic inflammatory bowel disease: the Proactive care pathway]

Inflammatory Bowel Diseases (IBD) cause diarrhea and abdominal pain that impair quality of life. Digestive damage frequently leads to undernutrition and sarcopenia, which worsen the prognosis of the disease. This led to the development of PROACTIVE, a multimodal prehabilitation program designed to improve the functional capacities, nutritional status and quality of life of IBD patients. 19 patients have been included in our pilot program, with an initial personalized multimodal assessment, 10 group sessions with 4 patients, and a final multimodal assessment proposing personalized care for home. Initial data are positive, showing an improvement in patients' physical capacity and quality of life after 6 weeks.

[Children with atopic eczema and their environment]

Taking an interest in the environment of a child suffering from eczema means understanding the word "environment" in the broadest possible sense: the child's lifestyle, family, social and cultural environment. By taking all these aspects into account, we can optimize the effectiveness of treatments, and avoid the multiple problems and comorbidities associated with moderate and severe eczema. It's up to caregivers to be vigilant about this, and to reposition the right gestures by spotting errors right from the start, even in the case of mild eczema. The best way to respond to this challenge, i.e. to help parents understand, is to draw on the principles of therapeutic patient education.

[Current issues surrounding Parkinson's disease]

The number of people suffering from Parkinson's disease is constantly increasing. Diagnosis is based on the motor and non-motor symptoms present throughout the course of the disease. To preserve patient autonomy, the main therapeutic challenge is to propose a treatment adapted to each profile, in conjunction with the implementation of non-medication strategies, reflection on improved accessibility to existing medication and research into innovative therapies.

[Taking into account the link between health and the environment]

Because of their weight and size, children are much more sensitive to environmental pollution than adults. They breathe, drink and eat more, and therefore absorb more potentially toxic substances, as the European Environment Agency points out. Challenges therefore lie ahead in a number of areas. As soon as pregnancy is announced, prevention and awareness-raising workshops are offered at the three Trousseau-Tenon-Pitié-Salpétrière maternity units of the Sorbonne Université-Paris hospital group of the Assistance publique-Hôpitaux de Paris. If a child is suspected of having food allergies and/or requires medical attention, the paediatric allergology department of the Armand-Trousseau hospital in the 12th arrondissement will be contacted.

[Perspectives on quality of life with endometriosis]

For women with endometriosis, pain, fatigue and digestive problems affect the quality of their daily lives. Many professionals work to help them find a balance between the disease and their activities, expectations and needs.

[Associations to promote access to care and recognition of obesity]

Patient associations bring many benefits to people suffering from obesity. What's more, through their actions, these associations contribute to the recognition of obesity as a pathology.

[Role of the MS nurse specialist in the patient's care pathway]

The specialized nurse in MS is a new profession practiced in MS clinics and outpatients specialized coordination structures. She is part of a specialized multi-professional team. The nurse must master a broad knowledge of the disease and the treatments. Have skills in therapeutic education, communication and coordination. She has a detailed knowledge of the resources of the care offer. The MS nurse thus participates in the assessment of the patient's needs for the implementation of a personalized care plan combining response to medical, paramedical, psychological and social needs.

[A therapeutic education program for patients with multiple sclerosis]

The MOTIV-SEP therapeutic education program for people with multiple sclerosis integrates the cognitive, emotional, behavioral and social components of therapeutic compliance. These components allow for an approach centered on the individual, in order to help him or her better support the important stage of starting treatment, but also to anticipate and reduce the obstacles to compliance.

[A patient education program for adolescents with anorexia nervosa]

Patient education program (PEP) aims to help the patient acquire the skills necessary to manage a chronic disease. A multidisciplinary TPE program for adolescents with anorexia nervosa was developed in a daycare hospital setting. This qualitative study, exploring the experience of the caregivers involved in this program, reports the benefits but more so the difficulties linked to the clinical specificities of anorexia nervosa, as well as the numerous requirements, constraints and necessary adjustments linked to this innovative practice.

[Path of a fighter]

Allergy is a frequent and often disabling condition for the patients. In the context of allergic rhinitis and asthma or anaphylactic shock to hymenoptera venom, allergenic desensitization can be proposed to limit the symptoms or recurrence of major reactions. Access to this treatment is made difficult by a lack of allergists, a lack of products or, more recently, by the Covid-19 crisis.

[Contribution of the clinical nurse specialist in urodynamics to continence maintenance]

The maintenance of continence is an objective of care that should not be neglected, especially with elderly patients. This care can be carried out through the first line nursing consultation or during the second line consultation. The main interest of it is to prevent, detect or treat a vesico-sphincter disorder that can cause anxiety, shame and isolation. The urodynamics nurse mobilizes her skills in the implementation of care actions, particularly in self-care education.

[Care pathway for the sickle cell child]

The management of sickle cell disease, the leading genetic disease in France, has made immense progress in recent years thanks to the creation of reference centres and multidisciplinary expertise. Pediatric mortality has almost disappeared, but the disease is still burdened with significant morbidity. The challenge for the coming years is to reduce this morbidity in order to improve quality of life and prevent chronic diseases, which occur mainly in adults.

[Therapeutic education and oral health, an opportunity for the child]

Early childhood caries is an infectious disease of bacterial origin. It is mainly associated with social inequalities in oral health and affects children from the least privileged backgrounds. Because of its recurrent nature, it is the most common chronic disease in preschool children. Since it shares common risk factors with a number of other chronic conditions (diabetes, obesity), promoting global oral health is essential to achieving a favorable general health status.

[The place of therapeutic education in the care of the sickle cell patient]

Therapeutic education is an integral part of the management of sickle cell patients. It includes the medical aspects but also the psychological, family and social repercussions of their chronic disease. It allows, at every stage of the patient's life, a care practice centred on the patient as a subject by offering him tools to become an effective actor of the management of complications, in the search for an acceptable quality of life.

[Management of the adult with sickle cell disease]

Sickle cell disease is a chronic disease with multisystemic complications. Follow-up requires specialised and multidisciplinary care. The consultation allows for the screening of complications.

Simulation Based Learning in internal medicine students

Introduction:

Few experiences have been reported in simulation-based learning (SBL) in internal medicine.

Aim:

To assess the SBL impact in internal medicine learning on learners' perception, knowledge acquisition, and cognitive and communication skills evaluation.

Methods:

A prospective observational study conducted in the Simulation Center at the Faculty of Medicine of Monastir between November 2018 and March 2019. High fidelity sessions were intended for lupus flare diagnosis and a standardized patient session for therapeutic education of patients on antivitamin K treatment.

Results:

A total of 118 third-year undergraduate medical learners split into 9 groups attended 9 SBL sessions. Regarding learners' perception, gain in communication was felt among 117 learners (99.1%) and gain in confidence among 116 of them (98.3%). As for SBL impact on knowledge acquisition, the overall median pre and post-test scores were 5.76 / 10 (4.61-6.92) and 7.69 / 10 (6.92-9.23) respectively (p = 10-3). The median overall improvement score was 2.3(0.76-3.07). Assessing learners' skills made it possible to highlight certain learners' shortcomings which we focused on during debriefing.

Conclusion:

According to the current study, SBL was associated with a high level of learners' satisfaction and was effective in optimizing knowledge and communication in lupus flare diagnosis and antivitamin K management.

[Training and follow-up of the dialysis patient at home]

Regardless of the home dialysis technique, training of the patient or caregivers is necessary. Formalized over several weeks, this is carried out by an expert nursing team. The patient must acquire the skills and knowledge to be able to dialyse effectively at home, in optimal conditions of safety.

[Promoting autonomy by redesigning support in psychiatry]

Therapeutic patient education in psychiatry is a unique form of support in which the relational aspect is used as a means of developing the patient's capabilities and awareness of the disorder. This time helps to support users' autonomy and favours health professionals' participative approach.

[Diabetic patients, knowledge respectives complications and severity]

Education is at the cornerstone of management of insulin-treated diabetic patient. Previous studies reported that the education of diabetic patients and their entourage was failing, hypothesizing that this lack of education was explained by a lack of knowledge on the disease and its complications and the underestimation of their respective severity. The "Educated Why" suggests that diabetic patients treated with insulin know that hypoglycemia and to a lesser extent diabetes itself are serious or very serious diseases.

[Follow-up with refugees during patient therapeutic education sessions]

The reception of a growing refugee population has confronted the team at our health centre with the challenge of managing chronic pathologies in patients who are in precarious situations in terms of financial resources, residence status and social rights. The organisation of the follow-up of chronically ill migrants as soon as they enter the care pathway and the adaptation of therapeutic education techniques to this vulnerable population seem to be able to constitute a way of social integration through care.

[Cardiac failure and remote monitoring: a new management approach?]

Heart failure is the leading cause of hospitalization of people aged 60-65 in France, with a rising rate of rehospitalization. This explains the very high healthcare costs in all Western countries and in the United States. Remote monitoring is one of the avenues being studied to reduce this rate of rehospitalisation: it is becoming a reality and should bring about changes in the nursing profession in the years to come.

[Early consultation after an acute decompensated heart failure episode]

Early consultation after acute decompensated heart failure supplements and reinforces the hospital care of patients with severe heart failure. Its aim is to prevent a new episode occurring during the period of increased vulnerability. It requires the active partnership of the patient and the complementary expertise of different professionals, specialised in heart failure and in therapeutic education : cardiologist, nurse and dietician.

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The nurse, a frontline player in therapeutic education. The ageing of the population and the growing number of people with chronic diseases is resulting in a significant need for therapeutic patient education (TPE). Nurses, by virtue of their training and their missions, are frontline players in the implementation of TPE, as demonstrated by the different perspectives of a student nurse and his practice placement tutor with the development of an educational booklet on the theme of "diet and diabetes".

[Creation of a tool to help assess eating disorders in young children]

In order to optimize the care of young hospitalized children with eating disorders, the Orality group at the Necker-Enfants malades University Hospital in Paris has created a therapeutic education tool: the Fleur des sens. This flower which is to be colored at the end of the meal with the child has nine petals representing nine foods that make up the meal, which were initially difficult or even impossible for the young patient to eat. This tool participates in the educational diagnosis and then in the formative evaluation of the child. It is also useful for the parents' understanding of the disease, making the link between sensoriality and food orality.

[Creative variations of a "Photographs" workshop in helping people to quit smoking]

In the field of addictology, care integrates activities that reactivate forgotten senses, emotions and postures. A "Photographs" workshop, led by a nurse in the addictology department, was modulated into a "Brief group photo-motivational intervention" to help people quit smoking. From this experience emerged an educational sequence of "Photo-Expression" integrated into the patient's therapeutic education programme "Help to stop smoking".

[An essential tool in the management of cystic fibrosis in childhood]

The follow-up of a patient with cystic fibrosis requires specific skills. The implementation of a comprehensive management approach gives convincing results in terms of survivability and quality of life. This is why the Cystic Fibrosis Resource and Competence Centres (CRCMs) bring together multidisciplinary teams in which nurse coordinators play a key role with patients, relatives and other healthcare professionals.

[A multidisciplinary collaboration for the benefit of patients]

A study focusing on therapeutic education sessions for patients with psoriasis receiving subcutaneous biotherapy was carried out in a dermatology department of a university hospital. To meet the needs identified by the research, multi-professional collaboration around a therapeutic patient education approach resulted in the creation and implementation of specific information tools and the organisation of training sessions for the nurses. A subsequent survey showed a 100% satisfaction rate among patients and nurses.

[Therapeutic education and pathway of the allograft patient]

After intensive chemotherapy followed by an allograft of haematopoietic stem cells, patients are immunocompromised for several months, or even years. They are vulnerable to bacteria and viral and fungal infections, and they must be made aware of the strict hygiene precautions to follow before they return home. Working alongside these patients in a therapeutic education approach, the nurse informs and guides them on the practices to adopt and the warning signs to look out for in the event of complications.

[Neuropsychopathology of amyotrophic lateral sclerosis]

Amyotrophic lateral sclerosis is a serious neuro-degenerative disease related to involvement of central motor neurons (cerebral cortex) and peripheral neurons (anterior horn of the spinal cord and motor nuclei of the medulla). Clinical progression is marked by extensive paralysis leading to death, most frequently by respiratory failure. Specific nursing care is required at each stage of the illness.

[Therapeutic education, a necessity for people with haemophilia]

Haemophilia is a chronic, restrictive and anxiety-inducing disease. In order to maintain a satisfactory quality of life, people can benefit from a therapeutic education programme to equip them with the skills they need to take care of their health.

[The lead nurse in a paediatric haemostasis unit]

In an approach of global collaboration, the lead nurse in a paediatric haemostasis unit uses her technical and educational role to participate in the management of the child's specific disorder. As a resource person, she coordinates the care and ensures the continuity of the child's care.

[Therapeutic education in children, progress and perspectives]

Therapeutic education in paediatrics forms part of the child's care pathway, from the discovery of the chronic disease, through to adulthood. Around fifteen years ago, this specific healthcare activity resulted in the creation of a multiple pathology therapeutic education centre at Robert-Debré university hospital in Paris. The centre has continued to develop over the years and further improved its interventions.

[Ageing of HIV-positive patients and nursing care]

Infection with the human immunodeficiency virus is no longer synonymous with premature death. The arrival and development of antiretroviral drugs has enabled it to evolve into a chronic disease, which nevertheless leads to a higher risk of comorbidities. These add to the other issues facing patients due to their advancing age. Therapeutic education provided by the nurse is essential in this context.

[Peer network for the therapeutic education of patients with type 2 diabetes in Mali]

Despite numerous health challenges, African healthcare systems are faced with limited financial and human resources. In this context, the epidemiological transition witnessing an explosion in the prevalence of non-communicable diseases, particularly diabetes, there are tremendous challenges to be met. Given the lack of human resources in these health systems, therapeutic education relies on networks of trained peer educator patients who also provide significant psychosocial support.

[Therapeutic education, a source of inspiration for students]

Therapeutic education contributes to improving the health of patients suffering from chronic diseases, their quality of life and that of their loved ones. It is complementary and inseparable from treatment and care, symptom relief and prevention of complications. Inspired by the modalities of this approach towards children suffering from cystic fibrosis, students from a nursing training institute in Ile-de-France share their work on this theme.

[Photolangage® workshops in the therapeutic education of obese teenagers]

A photolanguage workshop was organised as part of a therapeutic education day for obese teenagers. It is a valuable way of establishing links between their eating habits and their emotions, and to help them become aware of the benefit of psychotherapy. In addition this workshop helps to remove the common inhibitions of these young people, helping them to express themselves around the often painful experience of being overweight and their relational and family difficulties.

[Temporalities of care for obese teenagers]

Obesity in adolescents is a common reason for consulting a physician for angst associated with a need to lose weight. The multidisciplinary treatment takes into account the teenager's temporality. The duration of the initial treatment must be optimised in order to construct, with the teenager, a project which corresponds to his or her particular difficulties.

[Educating patients with chronic conditions cared for at home, a nursing initiative in Marseille]

Drawing on her hospital expertise in pulmonology, a currently private practice nurse describes her work supporting patients with chronic obstructive pulmonary disease in their home. In collaboration with hospital- and community-based teams, she uses a support tool to formalise therapeutic education sessions.

[The challenges of time in therapeutic education]

The notion of temporality is particularly important in the management of a chronic disease. Therapeutic education of the patient represents a holistic care approach in which his life history plays a role. Establishing a context favourable to personalised support requires one to consider one's cultural interactions. Adapted communication will favour an adjustment of behaviour and the improvement of one's quality of life.

[Dietetics and nutritional management of kidney failure]

Chronic kidney disease is associated with protein-energy malnutrition aggravated by chronic inflammation, the presence of comorbidities and old age. Standardising or reducing the intake of protein and salt are the first dietary objectives of patients with kidney failure. Patients' sodium intake must be monitored at every stage of the chronic disease. Regular nutritional follow-up is essential in order to detect malnutrition. Therapeutic education favours the compliance of the patient with the dietary recommendations.

[Health literacy and therapeutic education, converging objectives]

As part of the support provided to people with chronic diseases, nurses contribute to therapeutic patient education. This approach, drawing in particular on health literacy, aims to give people the skills needed for greater autonomy.

[Using connected objects to favour patients' adherence to physical activity]

A study explored the factors which can have an impact on the use of connected objects to improve patients' adherence to physical activity, when they suffer from chronic low back pain. The results can be used to adjust the development of an application aimed at patients with chronic low back pain.

[The TPE nurse improving the patient's quality of life]

The impact of interventions by therapeutic education nurses on compliance and the quality of life of patients with chronic diseases has been proven. These different perspectives of caregivers and patients highlight the specific case of the treatment of HIV.

[Nursing role and TPE in patients with lymphoedema of the limbs]

Lymphoedema, primary and secondary after cancer treatment, is a chronic condition which has a significant impact on patients' quality of life. Therapeutic education plays an important role in the initial care and in the follow-up of these conditions.

[Therapeutic education for patients with heart failure, a performance factor]

Heart failure is a little-known disease which is both frequent and serious. It is particularly concerned by therapeutic education as it is linked to a high level of avoidable hospitalisations and requires daily monitoring of simple clinical parameters. It also imposes a change of lifestyle on the patient.

[The coordination of community care for patients with chronic pain]

Patients with chronic pain require global and multi-disciplinary care. The network "Lutter contre la douleur" offers coordinated support for health professionals and a multidimensional assessment of the patients. Its therapeutic education programme favours learning of bodymind techniques. In this context, the nurse coordinator can play a key role in ensuring the efficiency of the patient management and health care pathway.

[Therapeutic education program on stroke for prevention of the vascular risk in women]

Stroke is a disease whose frequency is increasing especially in women and in the elderly, and that is associated with major functional impairment with adverse consequences in terms of quality of life. Implementation of a therapeutic education program is helpful for patients and their relatives so as to acquire skills to manage their own health, with the goal of reducing recurrences and improving personal experience of the disease.

[Avoiding peristomal skin problems]

Peristomal irritation is one of the most common complications in patients with a stoma. In many cases, prevention is limited to the care provided during the post-operative period. However, it can start before the operation by improving the physical condition of the patient. It continues during the perioperative period with the surgical technique. Prevention advice can be given during these three key stages of the patient's treatment.

[The nutritional education of patients with diabetes]

The nutritional education of patients with diabetes, in the hospital setting or in the community, is essential for ensuring good glycaemic control. It helps to combat preconceived ideas about diet and reinforces patients' autonomy in the management of their disease.