B Acad Nat Med Paris
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The physician-patient relationship involves both ethical and psychological aspects. The notion of empathy has been extensively described, and this "asymmetric dialogue" has been shown capable of affecting patient behavior. The Internet, and particularly medical websites, are modifying the physician-patient relationship by providing patients with knowledge of their disease, and are changing the social perception of medicine. More recent theories on medical relationships underline the importance of patience, tolerance and the ability to accept opposition and disappointment.
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A phenomenology of dreams searches for meaning, with the aim not only of explaining but also of understanding the experience. What and who is it for? And what about the nearly forgotten dream among the moderns, the banal returning to the nightmare, sleepiness, or dreamlike reverie. Nostalgia for the dream, where we saw a very early state of light, not a ordinaire qu duel. ⋯ Disappointment at the discovery of a cognitive permanence throughout sleep and a unique fit with the real upon awaking? An excess of methodological rigor where we validate the logic of the dream, correlating the clinical improvement in psychotherapy and the ability to interpret one's own dreams. The dangerous psychological access when the dream primarily is mine, viewed as a veiled expression of an unspoken desire, or when the dream reveals to me, in an existential conception of man, through time and space, my daily life, my freedom beyond my needs. Might its ultimate sense also mean its abolition? From the story of a famous forgotten dream, based on unexpected scientific data emerges the question: do we dream to forget? The main thing would not be consciousness but confidence, when " the sleeping man, his regard extinguished, dead to himself seizes the light in the night " (Heraclitus).
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B Acad Nat Med Paris · Apr 2011
[Thrombotic risk factors and antithrombotic treatment in atrial fibrillation].
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia, and its incidence is rising as the population ages. AF is therefore a growing source of cardiovascular morbidity and mortality due to thromboembolic complications and heart failure. The risk of embolic stroke is multiplied by about 5.6-fold in non rheumatic AF and by 17.6-fold in rheumatic AF Strokes due to AF are often fatal or disabling. ⋯ Current guidelines recommend vitamin K antagonist or dabigatran anticoagulation for patients with a CHADS2 score of 2. Patients with a score of 0 should receive either aspirin or no drug therapy, while patients with a score of 1 may receive either a vitamin K antagonist or aspirin. After successful AF ablation, the existing antithrombotic strategy should be pursued New strategies based on antithrombin or anti-Xa medications will probably have a better risk-benefit ratio.
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Burnout syndrome (BOS) is a psychological state resulting from prolonged exposure to job stressors. Because intensive care units (ICUs) are characterized by a high level of work-related stress, we reviewed the available literature on BOS among ICU-healthcare workers. Recent studies suggest that severe BOS (measured with the Maslach Burnout Inventory) is present in about half of all critical care physicians and one-third of critical care nurses. ⋯ Intensivists with severe BOS tend to be those with a large number of working hours (number of night shifts, and time since last vacation), whereas severe BOS among ICU nurses is mainly related to ICU organization and end-of-life care policy. ICU conflicts were independent predictors of severe BOS in both groups. Recent studies also identify potential preventive measures, such as ICU working groups, better communication during end-of-life care, and prevention and management of ICU conflicts.
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B Acad Nat Med Paris · Feb 2011
[Meeting the needs of families of patients in intensive care units].
As patients in intensive care units (ICUs) are not always able to decide for themselves, their family must receive thorough information on the diagnosis, prognosis and available treatments (unless the patient has expressed his/her opposition). It is crucial to provide this information before requesting the family's involvement. ⋯ Good communication and information are a source of comfort and empowerment for the family, especially in end-of-life settings. Finally, we examine areas warrantingfurther research on the family-physician relationship in ICUs.