[Parkinson's disease: intrinsically palliative care]

Multidimensional, chronic, progressive and incurable, Parkinson's disease is, by definition, a palliative disease, and this from the moment of diagnosis. This vision, relatively new to neurology, calls for a paradigm shift, as well as a dual medical-paramedical and home-hospital alliance. This approach allows us to better understand the specificities of Parkinson's disease and its treatments in terms of palliative issues.

[Addictions in the elderly: the viewpoint of an IPA working in EMPSA]

Many elderly people live well and at home, but some require somatic and psychiatric care. Mobile psychiatric teams for the elderly are called upon to intervene with people aged 65-70 and over who are experiencing psychological distress. Among senior citizens, addictive disorders are very common, and are associated with psychiatric and geriatric co-morbidities. Alcohol, tobacco and benzodiazepine use disorders require holistic, individualized care, based on identification, prevention and referral, as well as training and coordination of professionals and caregivers.

[The benefits of home visits for patients on home hemodialysis]

The success of home hemodialysis depends on several criteria. On the one hand, the patient's willingness to be autonomous, his or her degree of understanding, the technical feasibility at home, and the presence of a third party. Secondly, the quality of initial training (which must respect the patient's rhythm) and follow-up at home. This is a true patient-caregiver partnership, based on trust. Home visits are part of this approach, and help maintain the link, as a team at Caen University Hospital can testify.

[Setting up, running and evaluating NMIs as part of the "ageing well" project]

Non-drug interventions (NDIs) are recommended as a first-line treatment in gerontology to address the psychological and behavioral symptoms of dementia. This article illustrates the NMIs implemented, how they are carried out and how they are evaluated as part of the Bien vieillir project at Nice University Hospital.

[The benefits of home visits for peritoneal dialysis patients]

Peritoneal dialysis is exclusively an extrarenal purification technique performed in the patient's own home. The patient is either autonomous, or assisted by a private nurse or a member of his or her family. The nursing team at the center where the patient is being cared for organizes home visits to meet the patient and his or her family in their living environment. These visits provide an opportunity to review compliance with protocols and maintain the partnership with the patient. The team at the Caen Normandy university center for kidney disease shares its experience in this area of care.

[End of life at home, guiding relatives on what to do in case of dyspnea]

Respiratory difficulties presented by a loved one at the end of life at home can leave those around him or her unable to cope and lead to emergency hospitalizations that are not clinically justified in this context. This is why the educational role of nurses is so important. They contribute, through anticipated explanations and indications, to allow adapted attitudes likely to reduce anguish, even panic, and to make it possible to continue to live at home.

[The time of agony, know, understand to inform and explain]

The agony, this pivotal moment, which is more or less long, before death, is very anxiety-provoking. When the person and his or her loved ones want this last stage of life to take place at home, healthcare professionals play an important role in providing clinical support to the patient and creating the conditions for relative emotional security for everyone. This requires clinical knowledge and interpersonal skills to explain what is happening to loved ones, to reassure them and to accompany the life that is passing away. A nurse referent in palliative care sheds light on the challenges of this specific multi-professional practice at home.

[Management of congestive heart failure in the elderly after hospitalization for acute decompensation Interest of a dedicated territorial geriatric network ; the GERICCO-78 study]

AIMS

Heart failure (HF) is the leading cause of hospitalisation in the elderly in France. Early rehospitalisations are common, often through an emergency department. The aim of this study was to assess the impact of a primary care-hospital coordination network, with interventions by coordination nurses (IDEC), on the rehospitalisations after a first hospitalisation for acute decompensation in frail elderly HF patients.

METHODS

From 01/10/2019 to 01/10/2021, 237 patients aged > 75 years with frailty criteria, hospitalised in 8 departments of 5 private or public hospitals in the Yvelines Sud health territory were followed by an IDEC (hospital visit, telephone contacts, home visit(s)) within 3 months of their return home. This prospective observational study analysed the rate of consultations to the emergency room, rehospitalisations (total and for acute HF), and the number of events avoided at 90 days after discharge.

RESULTS

The mean age of the patients was 87 years, 54% were women, 68% had a left ventricular ejection fraction > 40%, and 70% had atrial fibrillation. Non-cardiac comorbidities were very frequent. At 3-month follow-up, mortality was 9.3% (22/237), only 27 patients (11.3%) consulted the emergency room for acute HF, and the rehospitalisation rate for HF was 19.8%, without difference according to left ventricular ejection fraction. A consultation to the emergency room or a rehospitalisation for heart failure could be avoided for 10% of patients.

CONCLUSION

This study suggests that a primary care-hospital coordination network with dedicated coordination nurses is useful for the management of very elderly frail patients following hospitalisation for heart failure, limiting visits to the emergency room and rehospitalisations.

[Evolution of the nursing profession]

The choice of private practice is determined by a zoning of installation intended to distribute the professionals more equitably. While there are many administrative constraints, these nurses, who are both generalists and specialists in different fields, are increasingly involved in the co-development of care and health projects with other professionals. Not counting their hours and confronted with conflicts of values, they are not spared from suffering at work.

[Therapeutic patient education in the city by private nurses]

Therapeutic patient education (TPE) is part of the nurse's role, but a minimum of 40hours of training is required to practice in a national or regional program. Offering TPE requires a good command of the pathologies concerned, finding the time to proceed in a way that is comfortable for everyone, identifying the health professionals who intervene in the home. But also showing adaptability to accompany the patient towards autonomy.

[Coordination mechanisms, tools for decompartmentalizing the city and hospital]

According to specific medical and social, health related and public policy variations, coordination professionals ensure the return to and/or remain at home of the most vulnerable people. Today, the notion of networks has evolved towards the grouping of professionals into communities, with the objective of sharing and coordinating patient care in order to improve health care pathways through clearer actions and fluider follow-ups.

[The care pathway coordination nurse, an emerging profession]

The care pathway coordination nurse acts in close collaboration with the various professionals in the health, social and medico-social fields to improve the patient's pathway. His or her coordination of the care pathway, over a given period of time, promotes personalized support within the framework of structured care that also considers the patient's health and life paths.

[The coordination support device to facilitate patient referral]

In the continuity of institutional care, it is important to visualize the return home as a possible entry into a new institution, an interdepartmental transfer. This allows to position oneself in a logic of decompartmentalization of two worlds - the city and the hospital - that seem to be quite distinct until now whereas they are entirely part of a single pathway for the supported person. This change of place is the logical consequence of the acute episode of hospitalization.

[Assessment in the home of the elderly following a first fall with Samu intervention]

The Rising-Dom study is a project to evaluate the impact of home intervention by an experienced geriatric nurse on mortality and institutionalization of older people who fall. It is a multicentre randomised interventional study. The two-year follow-up will compare the evolution of two groups: intervention (assessment by the nurse and proposal of a care plan) vs. usual care (simple information on ageing well and on the prevention of falls at home). First feedback from the field.

[Nursing practice and end of life support at home]

Accompanying a person at the end of life at home requires skills to alleviate symptoms and the availability to take care of the person and his or her loved ones. Interdisciplinary teamwork helps to give meaning to the care project and to cross the views on complex issues.

[Day hospital, a link specific to the patient]

In the palliative care day hospital of Marie-Galène health centre in Bordeaux, care is provided in two different ways: through the interdisciplinary individual day hospital and the collective day hospital in the form of group days. In both cases, the palliative approach guides the team's reflection regarding the anticipation of complex situations and quality of life. The health crisis has had a significant impact on the activity of this service.

[A central role for the home care nurse in the assessment of the severity of sepsis]

En 2016, la conférence de consensus Sepsis 3 a mis en avant le score Quick Sepsis-related Organ Failure Assessment en complément du raisonnement clinique paramédical pour évaluer la sévérité et le risque de mortalité du sepsis À l'hôpital, ce score permet de dépister précocement le sepsis à risque d'évolution défavorable Sa mise en œuvre par les infirmiers à domicile devrait permettre de réduire la morbi-mortalité du sepsis, soulignant le rôle essentiel de ces professionnels dans l'activation de la chaîne de survie du sepsis.

[When care means being present for the other]

What risks does coronavirus pose to people not infected with covid in palliative care? Between certain death and uncertain covid, how can caregivers support what helps patients live while protecting them from what could make them die? It is important to be aware of what is vital to protect, but also examine the advantages and limitations of the digitalisation of care.

[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.

[Dialysis at home]

Home dialysis is an effective and safe care strategy that promotes patients' quality of life. At the collective level, it responds to the medico-economic challenges of the French healthcare system. Although it has few contraindications, it remains under-used in France. Its implementation requires early information for patients and their families, as well as the organisation of personalised follow-up by a dedicated and trained team.

Besoins des proches aidants qui accompagnent une personne en soins palliatifs et de fin de vie à domicile

Le maintien à domicile d'une personne en soins palliatifs et de fin de vie (SPFV) dépend grandement de la présence quotidienne de proches aidants (PA) et de leur implication dans les soins. Or, les besoins des PA tout au long de la trajectoire d'accompagnement d'un proche en SPFV à domicile sont encore relativement méconnus.

Objectifs et méthode

Cette étude qualitative descriptive s'intéresse au rôle des PA qui ont accompagné une personne recevant des SPFV à domicile dans le but de décrire leurs besoins tout au long de la trajectoire d'accompagnement. Ainsi, 20 PA ont participé à des entrevues semi-dirigées.

Résultats et discussion

L'étude met en lumière les besoins multiples des PA qui accompagnent un proche en SPFV à domicile. Les besoins informationnels, émotionnels et psychosociaux démontrent que les PA connaissent des changements dans leur rôle auprès de la personne malade. Les besoins spirituels ont été rapportés en termes de sens donné à l'expérience d'accompagnement. Enfin, les besoins pratiques mettent de l'avant l'importance d'avoir accès aux services de SPFV 24 h/24 et le caractère essentiel du soutien de l'infirmière.

Conclusion

Les besoins des PA qui accompagnent une personne en SPFV à domicile sont peu satisfaits. Il importe d'en tenir compte dans la trajectoire de soins, parallèlement aux besoins de la personne malade, afin d'améliorer l'expérience d'accompagnement qui précède la période de deuil.

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Body and culture, nursing approach in home care. Working extremely closely with patients' bodies when they provide care in the home, nurses interact with households' private spheres. The intercultural dimension of their competencies enables them to approach the references and beliefs of their patients and to create with them the conditions favourable to the provision of care and relief for their unhealthy bodies.

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Illness and grieving the loss of a healthy body. Grief is a phenomenon which is part of the normal and the pathological. In the case of illness, it is felt for a body which is lost, different, becoming something other. This article studies the notions of grief, body schema and body image.

[Determinants of home delivery in two neighborhoods in Commune V of Bamako]

OBJECTIVE

The objective was to study the determinants of home delivery in the Commune V Health District of Bamako.

MATERIALS AND METHODS

We conducted an analytical cross-sectional study among women who delivered at home, in two neighborhoodsofSabalibougou and Badalabougou, from March 2015 to February 2016, and who were admitted at the Maternity of the Commune V Referral Health Center during the same period. Two groups of women from two neighborhoods were compared. The data were entered and analyzed using EpiInfo 3.5.3. We presented the Odds Ratios and confident intervals.

RESULTS

The frequency of home delivery was 16.18%. The age group 35 years and over were the most represented in both Sabalibougou with 80.75% and Badalabougou with 19.42%.In Sabalibougou, compared to Badalabougou, we found 0.49 times fewer women in school (p = 0.01); 8.92 times more women with gainful occupation (p = 10-8); 3.5 times more partners with non-gainful occupation (p = 10-6); 4.59 times more risk to give birth at home (p = 10-8); 3 times more risk not to perform antenatal care (p = 0.0002); 3.26 times more appreciation of the high cost of delivery care (p = 10-4) and 3.03 times more lack of financial support (p=3*10-4).

CONCLUSION

The frequency of home delivery was higher in Sabalibougou. The determinants of this phenomenon were: the low level of schooling, the low socioeconomic level, the non-use of antenatal care, theperceived high cost of delivery care.

Les réseaux territoriaux de cancérologieTerritorial oncology networks

In the often long and difficult care pathway of patients with cancer, the oncology care network has an important role to play. Of all the coordination programmes, it is the one which enables the patient's medical and psychosocial situation to be constantly evaluated throughout their illness.

[Palliative care in rural areas- it's possible!]

Many rural areas, far from hospitals, are seeing a decline in the number of general practitioners, making it more difficult for patients in these regions to access care. However, there are relevant solutions, as illustrated by the Dousopal network in Normandy, which, teaming up with home care providers, contributes to organising palliative care support for all, in optimal conditions.

[Digital technology and nursing practice, opportunities and disparities between hospital and community care]

While the use of digital technology has developed in nursing practice in the hospital setting, this movement is late to arrive in homecare. Structural factors can explain these disparities, which are also due to insufficient training of private practice professionals and the fact that digital tools are not always suited to their mode of practice. However, there are adapted and innovative solutions, such as platforms for the organisation of homecare.

[Training in haemophilia aimed at private practice nurses]

At the crossroads between the care delivered in the hospital and community nursing care, private practice nurses occupy a central role in supporting children with haemophilia and their family. Dedicated training helps to maintain the link with hospital structures and enables them to exchange with other professionals regarding practices, treatment difficulties and the contribution of new technologies in the care provision.

[Bringing paediatrics into the home]

In-home hospital care provides a good vantage point from which to understand the evolution of paediatric care. It is in fact in line with the main ambitions of paediatrics today, by ensuring that children can remain with their parents in their familiar environment. The model may seem ideal. There are however constraints, such as the risk of confinement for the children and their parents and the difficulty, for the caregivers, of entering a private space which has not been designed for healthcare ergonomics.

[Nursing practice in the mobile old age psychiatry team]

Since 2015, the mobile old age psychiatry team of the Maison-Blanche public health facility has been providing mental health and psychiatric services to the population aged 70 and over in three districts of Paris and four psychiatric sectors. The team's nurses actively take part in delivering care in the home and in maintaining the autonomy of elderly patients suffering from mental health disorders. They provide global care, both somatic and psychiatric, and offer, through their assessments, an initial response to the suffering expressed by the patients and their family.

[Benefit of hypnosis in in-home nursing care]

Treating pain is a priority for caregivers and patients. With in-home care, nurses care for patients who are sometimes in pain and for whom they implement treatments prescribed by the doctor. A nurse and a doctor describe here the complementary contribution of hypnosis in the treatment of pain, including in in-home nursing practice.

[Shared medical decision-making at the end of life, the role of the home health nurse]

Caring for patients approaching the end of life in their home requires multidisciplinary reflection on the part of all caregivers. Informing the patients and their families as well as taking into consideration all aspects of the support needed must lead to decisions being made as a team. Global care can then be provided based on a joint care project.

Artificial Domicile Use by Bumble Bees (Bombus; Hymenoptera: Apidae) in Ontario, Canada

Bumble bees are an important group of pollinating insects that are of increasing conservation concern due to relatively recent and dramatic species-specific declines. Nesting ecology can vary significantly between species, and nest site selection may be affected by many factors, including heredity, individual experience, and habitat availability. Data on bumble bee nesting ecology are inherently difficult to collect in the wild as nests are often cryptic. Artificial domiciles (nest boxes) can be a useful tool for gathering information on species-specific nesting behavior to inform conservation management of native pollinator populations. The aim of this study was to examine the use of three different domicile designs for monitoring bumble bees: aboveground, underground, and false underground, while collecting information on occupying species identity and richness to compare with sampling with traditional netting survey methods. Across Ontario, the majority of sites had at least one domicile occupied, with the aboveground installation method proving most successful whereas no false-underground domiciles were occupied. Occupied domiciles appeared to preferentially sample certain species compared to netting surveys, and rarefied species richness of both methods was similar. Given that some bumble bees did occupy artificial domiciles, and species richness relative to sample size was high, with further refinement, this method may be useful for bumble bee research and monitoring: filling in nesting ecology knowledge gaps and potentially as a conservation management tool.

[The adaptation of society to ageing today]

Living at home as long as possible, adapting 'old age' policies to dependent elderly people, using new technologies to enable elderly people to remain at home and funding dependence are just some of the challenges facing today's society. The law relating to the adaptation of society to ageing was constructed around the notion of autonomy. This article presents an overview of this complex patient management.

[Fragilty of elderly people in Quebec, the role of the nurse]

The ageing of the population is an issue which concerns the whole planet and Quebec is no exception. When caring for fragil elderly people, the nurse's role is deployed in different contexts. Care in the home is often prioritised and innovations are emerging to promote professionals in this area. In the hospital setting, notably, there is a programme in which the nurse is given a central role. This article presents an overview of the challenges in terms of training and long-term care.

[Treatment of chronic kidney failure by haemodialysis]

Haemodialysis is the most frequently used renal replacement therapy for chronic kidney disease. Much progress has been made in this field since the invention of this technique. The nurse nevertheless continues to play an essential role. Kidney transplantation is gradually becoming the first-line treatment, the aim of dialysis being to prepare patients for this procedure.

["The acceptance of dialysis as a part of everyday life is a long road"]

Dialysis is often seen as a burdensome constraint. The word induces fear, all the more so as it evokes the image of a patient, attached to a machine some twelve hours a week, undergoing a debilitating treatment in a highly medicalised setting. However, it is possible to gradually accept this renal replacement therapy by being supported and trained to use it independently. A patient undergoing dialysis shares his story.

[Organising and supporting the end of life when faced with a refusal of care]

Often ethically complex, end-of-life situations can mean nursing teams are confronted with a refusal of care. Through a representative clinical situation, a nurse describes the support provided by a multidisciplinary team, in the home, to comply with the wishes of a person at the end of life, support the family, anticipate possible difficulties and organise adapted care which respects all those concerned.

[Environmental health education]

Environmental health education aims to reduce the impact of risk factors for patients. The caregiver's role is to adopt a positive education approach with concrete ways of controlling the living environment. He or she must support people in asserting their choices in terms of health and to make their own contribution to reducing risks.

[Mother-baby follow-up at home and the welcome of the baby in the family]

Upon discharge from the maternity hospital, the newborn is welcomed not only in a home but also within a family. The postnatal follow-up over the first few weeks can take several forms: a programme to support the return home, hospital at home service or follow-up by a private practice midwife or professionals from the mother and infant welfare protection service. The aim is to meet the needs of the baby, favour the establishment of the parent-baby bond and to support the construction of parenthood.

[The private practice nurse and environmental health]

Each day in France, more than 110 000 private practice nurses deliver care, in a context of the development of early discharge from hospital. Their role in environmental health is essential for the patient as well as for the healthcare pathway.

[Childbirth support by children's nurses from the mother and baby welfare protection service]

As the stay in maternity hospitals gets shorter, parents often feel helpless upon their return home. It is therefore necessary to identify resource professionals to help them on the continuation of the care pathway. The children's nurses from the mother and infant welfare protection service, a frontline service accessible to everyone, provide their expertise to meet the basic needs of the child and support the parents in the development of their skills.

[Supporting people with Diogenes syndrome]

Diogenes syndrome is a chronic condition often affecting elderly people, especially those living in isolation. It is characterised by self-neglect and compulsive hoarding. Medico-social professionals working with people in their home, have reflected on levers to help improve the complex support of these patients.

[Private practice nurses and support for patients' return home in cardiology]

The Prado Cardio programme is designed to support patients' return home and helps to identify the early warning signs of heart decompensation, thereby avoiding unscheduled hospitalisation. It also gives private practice nurses the chance to develop new expertise. The follow-up is personalised and established jointly with the patient and the multi-professional team.

[Private practice nurse and palliative care in the home]

The development of palliative care in the home, requested by patients and recommended in the 2015-2018 national plan, requires the home to be considered as a specific place of care. Private practice nurses have an important role to play with the patient and their relatives, in the assessment of needs, coordination, relational care as well as in providing the care required for maintaining and continuing life, an increasingly technical process.

[Caring for patients and their families in their home]

When a patient with glioblastoma and their families wish, a hospital at home scheme can be put in place, providing care and support for the patient in the palliative phase. The quality of life of the patient remains the priority and special attention is paid to the family.

[Adaptation of the home, the occupational therapist's assessment]

When the functional independence of elderly people starts to diminish, the choice of adapted assistive devices and some simple modifications to the home can allow them to continue to perform their daily tasks safely and easily. Likewise, when physical dependency is established, the choice of relevant assistive devices enables these people to continue living in their home in the right conditions, both for the person concerned as well as for their direct carers. In these different situations, the assessment by the occupational therapist enables the solutions to be adjusted to the capacities, the morphology and the lifestyles of the elderly person.

[Nurse coordinator and doctor coordinator in a gerontology network]

The Marseille gerontology network consists of a geriatric team providing support in patients' homes across the Marseille urban area. It forms an integral part of the geriatric care sector ensuring that elderly people living at home benefit from a global medical-psychological-social assessment. The aim is to enable elderly people to continue living and receiving care in their home.

[Specialised Alzheimer's teams at home]

Specialised Alzheimer's teams aim to optimise the autonomy and quality of life of patients and their carers in their home.

[The remote monitoring of chronic wounds treated in the home]

The Franche-Comté Regional Health Authority, in collaboration with the chronic wound outpatient centre of Besançon university hospital and twelve volunteer sites, has developed a remote patient monitoring programme for monitoring chronic wounds in the home. It has been used by private practice nurses since 2009.