The Autonomization Principle in Vascularized Flaps: An Alternative Strategy for Composite Tissue Scaffold In Vivo Revascularization

Autonomization is a physiological process allowing a flap to develop neo-vascularization from the reconstructed wound bed. This phenomenon has been used since the early application of flap surgeries but still remains poorly understood. Reconstructive strategies have greatly evolved since, and fasciocutaneous flaps have progressively replaced muscle-based reconstructions, ensuring better functional outcomes with great reliability. However, plastic surgeons still encounter challenges in complex cases where conventional flap reconstruction reaches its limitations. Furthermore, emerging bioengineering applications, such as decellularized scaffolds allowing a complex extracellular matrix to be repopulated with autologous cells, also face the complexity of revascularization. The objective of this article is to gather evidence of autonomization phenomena. A systematic review of flap autonomization is then performed to document the minimum delay allowing this process. Finally, past and potential applications in bio- and tissue-engineering approaches are discussed, highlighting the potential for in vivo revascularization of acellular scaffolds.

[Enzymotherapy infusion in home hospital care]

The six pediatric care units of the Assistance publique - Hôpitaux de Paris home hospitalization service provide daily care for 150 children. A small proportion are treated for enzyme-deficiency diseases at the reference centers of the Necker-Enfants malades and Armand-Trousseau hospitals. Treatment consists of a weekly injection of enzyme therapy, lasting from three to five hours. In order to reduce the time spent by the nursery nurse, while guaranteeing the quality and safety of care, a team discussion led to the drafting of a procedure for harmonizing practices and empowering families to carry out this enzymotherapy injection.

[The Équilibres experiment, a paradigm shift in home care]

It was in 2019 that the Equilibres nursing teams began to be deployed in three metropolitan regions: Hauts-de-France, Île-de-France and Occitanie. This organizational experiment, authorized by the Article 51 of the Social Insurance Financing Law, targets home nursing and mobilizes caregivers committed to patient autonomy and responsible regarding public health expenses.

[Accompanying the pediatric/adult service transition in chronically ill patients]

The transition is a key step for adolescents with chronic illnesses, as they are at risk of a disruption in care, complications and even mortality. Accompanying this process is based on two axes: autonomization of the young person (acquisition of knowledge and know-how in a perspective of empowerment) and structuring of the care pathway (transition measures, pediatric/adult service coordination).

Practitioner Empowerment, Older Adult Mistreatment, and Dementia

Although some studies have revealed practitioner disempowerment in cases of older adult mistreatment, this experience is poorly understood. In addition, dementia and contextual influences further complicate cases; yet,  little is known about the experience of practitioners with this complexity. This critical inquiry, based on Critical social theory, critical consciousness, and professional agency, aimed to address these gaps. Fifty-one practitioners from diverse health care and social service disciplines from rural and urban communities in Northeastern Ontario participated in interviews, journals, and focus groups. Analysis of data revealed the need for empowerment within a perpetual cycle of non-resolution, to refocus on legal clarity and intervention versus the current legal complexity and education focus, and to develop adequate infrastructure to support interprofessional efforts. The infusion of this knowledge into policy, practice, and research has great potential to improve outcomes for older adults with dementia who are mistreated in their homes.

[Evolution of the care relationship]

There is a new role for relational aspects in care. A sociological approach can identify different dimensions of care as a collective care production. We can link this production to that of autonomy as a process in which the narrative and reflective dimensions occupy a new role. They lead to making relational modes visible by formalising them. In doing so, they participate in their transformations.

[Anorexia, the passage from adolescence to adulthood]

Anorexia engages all those close to the patient in accepting and following the treatment process. Indeed, the continuity of the treatment depends on the quality of the connections which the person with anorexia develops with his or her parents or partner. The caregivers must be involved and understand what is at play notably with the passage from adolescence to adulthood.

A Critical Perspective on Relations between Staff Nurses and their Nurse Manager: Advancing Nurse Empowerment Theory

This study considers empowerment in nurse-manager relations by examining how conflict is handled on both sides and how the critical social perspective has influenced these relations. The authors use inductive analysis of empirical data to explain how (1) nursing work is organized, structured, and circumscribed by centrally determined policies and practices that downplay nurses' professional judgement about patient care; (2) power is held over nurses in their relationship with their manager; and (3) nurses' response to power is to engage in strategies of resistance. The authors illustrate how power influences relations between staff nurses and managers and provide a critical analysis of the strategies of resistance that result in personal, relational, and critical empowerment among staff nurses. Through resistance, staff nurses engage in alternative discourses to counteract the prevailing neoliberal organizational and managerial discourses of efficiency and cost-effectiveness.

[A tool for helping psychiatric patients regain their autonomy]

The "Hygiène de vie" ("personal health practices") group is a nursing initiative and innovative tool helping patients to regain their autonomy and facilitating their resocialisation as close as possible to their living environment. An approach centred on the links with network partners is essential, as the team of the adult day care center in Vaulx-en-Velin testifies.