[Ethical reflection in structures, a compass in the crisis]

Morality, ethics, ethical approach are words that are often used in our daily lives as health care providers. What meaning do they have? How important are they? If ethics is an individual notion, the question arises of its application in our accompaniment.

["Breaking the Silence Barrier", a simulation program to address psychological distress]

Although several strategies have been developed to support medical students during their studies in order to prevent burnout, depression and suicide, not all of them are equally effective. Simulation is an interesting strategy: it gives students the tools to detect and intervene in signs of distress in their colleagues, and helps them break the barrier of silence in the face of psychological distress.

[The role of the health executive with the residents in Ehpad]

The personalized quality support for residents of residential establishments for dependent elderly people, specified in the law of January 2, 2002, is implemented through various tools and regular evaluations. The health executive, as the central link in the chain, has a key role to play in carrying out these actions, which are part of a continuous quality improvement process.

[Inappropriate admissions of Ehpad residents to emergency departments]

After a review of inappropriate admissions of residents of residential care facilities for the dependent elderly (Ehpad) to the emergency room, we propose ways to reduce them. They include giving the coordinating physician a clinical role, organizing continuity and permanence of care in all Ehpad, signing agreements between Ehpad and hospital for direct hospitalization and collaboration with mobile teams and geriatric hotlines, generalizing the level of medical intervention in Ehpad, and deepening the training of Ehpad caregivers in geriatrics.

TLC-Act: A Novel Tool for Managing Drug Interactions

Background

Clinical decision support systems (CDSS) are used by pharmacists to assist in managing drug-drug interactions (DDIs). However, previous research suggests that such systems may perform suboptimally in providing clinically relevant information in practice.

Objectives

The primary objective of this study was to develop a novel DDI management tool to reflect the clinical thought process that a pharmacist uses when assessing a DDI. The secondary objective was to investigate practitioners' perceptions of this tool.

Methods

This study was conducted in 3 phases: development of the DDI management tool, implementation of the tool in clinical practice, and collection of practitioners' opinions of the tool through an online qualitative survey (although because of circumstances related to the COVID-19 pandemic, the study population for the survey phase included only pharmacy residents). A comprehensive literature search and analysis by an expert panel provided underlying context for the DDI management tool. The tool was validated through simulation against a known list of DDIs before implementation into practice by hospital pharmacists and pharmacy residents. Participating pharmacy residents were invited to provide feedback on the tool. Survey results were analyzed using descriptive statistics.

Results

The novel tool that was developed in this study (called TLC-Act) consisted of components important to a pharmacist when assessing a DDI, including the duration of concomitant use of the interacting medications and patient-specific risk factors. Study participants implemented the tool in clinical practice for a total of 6 weeks. Of the 28 pharmacy residents surveyed, 15 (54%) submitted a response, of whom 11 (73%) found the TLC-Act tool to be slightly more useful for assessing a DDI than usual care with the CDSS alone.

Conclusions

The TLC-Act tool maps out a pharmacist's clinical thought process when assessing a DDI in practice. This novel tool may be more useful than a CDSS alone for managing DDIs, as it takes into account other important factors pertinent to the assessment of a DDI.

[Freedom in the protected sector and COVID-19]

It is difficult on a daily basis to reconcile security and freedom, particularly the freedom to come and go of residents in accommodation facilities for dependent elderly people, and more specifically in the protected sector. With the COVID-19 epidemic, everyone experienced the effects of the lack of freedom. This echoed what residents may experience on a daily basis in institutions, where their freedom is often abused. If the effects of confinement are beginning to be studied in the general population, what about the repercussions on residents already weakened by the disease? How did they experience it? The deprivation of freedom acts on our emotions, on our psyche, in different ways. We will certainly have to learn from this period, notably on the importance of feeling free even in an institution.

[COVID pandemic in accommodation facilities for dependent elderly]

During the coronavirus outbreak, accommodation facilities for dependent elderly (Ehpad) had to adapt quickly to an unknown and dangerous situation for residents, putting all the resources of these places to the test. Caregivers faced clinical and organizational emergencies with the coordinating doctors and nurse, going through different individual and collective phases. The directors, who are legally responsible for Ehpad, had to make room for the "we", anticipate, apprehend and evaluate the crisis but also deal with paradoxical recommendations.

Factors Influencing Inpatient Insulin Management of Adults With Type 1 and Type 2 Diabetes by Residents and Medical Students

OBJECTIVES

The day-to-day management of diabetes is often the responsibility of resident physicians in teaching hospitals, yet studies have consistently shown that learners lack confidence and knowledge of inpatient insulin titration. We sought to elucidate factors that influence inpatient management of diabetes by medical learners. We predicted that there would be conscious and unconscious variables at play, and we sought to determine the process by which learners arrived at insulin titration decisions.

METHODS

We administered a survey using a hypothetical case based on script concordance testing in 88 medical students and residents at the University of Calgary. We used multilevel, mixed-effects linear regression and random-effects meta-analysis to compare clerks' and residents' insulin prescribing, confidence in prescribing decisions and concordance with endocrinologists.

RESULTS

Residents had higher confidence than clerks, yet were less concordant with the insulin decisions of staff endocrinologists. Both residents and clerks prescribed more insulin when the reported blood glucose was higher, or the patient had positive ketones and prescribed less insulin when the patient had hypoglycemic unawareness. Residents prescribed a higher dose of insulin when the charge nurse reported the result compared with a student nurse, but this variable did not significantly impact prescribing by clerks.

CONCLUSIONS

We propose a model in which learner factors (knowledge, confidence, experience), patient variables and perceived expectations influence insulin titration decisions via analytical and heuristic processes. We propose that educational interventions designed to improve inpatient glycemic control must, therefore, address both knowledge and systems factors.

[A place for intimacy and sexuality in nursing homes]

In nursing homes, intimacy is threatened by the increased dependence and lack of support. It is nevertheless possible to preserve it, meaning it is possible to ensure a continuity of existence for the elderly person in an institution.

[Non-pharmacological therapies and neuropsychological disorders in institutions]

Non-pharmacological therapies are now used in many nursing homes often with residents presenting a risk of behavioural disorders. They include music therapy, animal-assisted therapy, physical activity as well as other approaches such as light therapy or aromatherapy. It requires rigorous assessment, the permanent involvement and engagement of residents as well as the staff as part of a compassionate and participative approach.

[Restraint in nursing homes, the psychologist's point of view]

With regard to restraint, the caregiving teams are confronted on a daily basis with various issues which reveal a clash between the respect of a person's rights and dignity and the need to protect and provide a safe environment. The triangular relationship between the resident, their family and the multidisciplinary caregiving team can result in the construction of a response to this dilemma between liberty and safety.

[Motility disorders in the elderly]

Motility disorders are frequent, especially in the elderly. They must not be ignored and require a systematic evaluation. Constipation, which many elderly people suffer from, must not be trivialised as it can impact on quality of life. Diarrhoea, the manifestation of which is more acute, requires fast and adapted treatment.

[Caregivers in geriatrics: burnout and loss of meaning]

The burnout of caregivers in geriatrics reveals a serious loss of meaning: that of 'ageing', of the status and the function of old age in the process and orientation of life. Faced with this challenge, the key is to find meaning in one's work. In geriatrics in particular, caregivers play a valuable role of 'conveyor'.

[Life project of residents and institutional approach in nursing homes]

The life project in a nursing home involves all the players concerned: first of all, the resident, then the caregivers, the families and the institution. This unifying tool, organised around the elderly, helps to develop collective competencies, favours the integration of new residents and reassures families. This article presents a nursing home's experience of setting up a life project.

[Delirium in a nursing home: a survey of general practitioners]

Delirium is all the more frequent and serious when it occurs in a nursing home. A study was carried out to assess the current practices of general practitioners in the management of delirium in a nursing home in order to identify the issues involved and to suggest areas for improvement. The doctors identified three main difficulties: the management of behavioural disorders, the conditions of practice of a private practitioner in a healthcare institution and the relations with the different caregivers of the nursing home.

[Assessment of the use of music therapy with nursing home residents]

A study analysed, on the one hand, the efficacy of the use of music therapy with residents and, on the other, the feasibility of the implementation of such a technique in nursing homes and in follow-up and rehabilitation units. In this context, music therapy seems to be an effective alternative to traditional approaches.

[Improving the quality of life of residents]

The socially interactive therapeutic robot Paro is presented in the form of a soft toy. It can benefit patients suffering from Alzheimer's as well as nurses.

[Internal and external assessment of nursing home residents' satisfaction]

Quality improvement procedures and measuring the satisfaction of nursing home residents is a major priority. A study assessed the differences between the results of a survey conducted by internal staff and of one carried out by an external service provider to evaluate the satisfaction of the residents of a nursing home.

[Reinforced accommodation units and the management of patients with dementia]

Dementia is frequently associated with behavioural disorders that can be difficult to manage. In regards to these symptoms, psychoactive drugs are not very effective and have many potential side effects. In order to take care of patients with such severe disorders, specific units called "reinforced hosting units" ("UHR; Unités d'Hébergement Renforcées" in French) have been developed within long term care units. Specifically trained teams take care of these patients in specially designed settings. A French national inquiry has studied the development, the characteristics and the activity of these units in 2013 and 2012.