Implication du médecin généraliste dans la continuité du traitement de l'urgence PDF Download

Author: Laurent Walczak
Publisher:
ISBN:
Category :
Languages : fr
Pages : 148

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Author: Béatrice Goujet
Publisher:
ISBN:
Category :
Languages : fr
Pages : 62

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L'abstention thérapeutique ou la limitation des traitements est une question délicate à laquelle les médecins généralistes sont confrontés, en particulier auprès des personnes âgées souffrant de polypathologies et parfois de handicaps. Alors que des recommandations hospitalières existent, ainsi qu'une récente loi relative aux droit des malades et à la fin de vie, nous avons cherché à savoir comment les médecins généralistes vivaient ce type de situation au quotidien. Méthode – Pour cela, nous avons réalisé une étude qualitative à partir d'entretiens semi-dirigés auprès de vingt médecins généralistes tirés au sort sur l'ensemble du département de la Loire. Nous leur avons proposé de décrire la dernière expérience pour laquelle ils avaient été amenés à décider de la mise en oeuvre d'une abstention thérapeutique, ou une limitation des soins chez un patient de plus de 75 ans. Il s'agissait de préciser le contexte, d'identifier les personnes qui étaient intervenues dans la décision, de décrire la décision prise est ses conséquences, et de savoir enfin si les traces de cette décision apparaissaient dans le dossier médical. Les situations qui ont conduit les médecins généralistes à la décision d'abstention thérapeutique, ou de limitation de traitements, sont hétérogènes. Parfois la décision a été prise dans l'urgence. Les médecins décrivent des relations relativement simples avec leurs patients qui sont, lorqu'ils sont conscients et compétents, informés et consentants. Le refus de soins par les patients restent cependant une situation difficile pour les médecins généralistes. Ceux-ci notent l'absence de demande anticipée, et de personne de confiance désignée. Par contre, ils soulignent les difficultés relationnelles qui interviennent fréquemment dans les familles et qui peuvent compromettre la décision. Les médecins généralistes soulignent leur solitude dans la décision. La relation avec le personnel paramédical est souvent perçue comme délicate, du fait de l'absence de lieu d'exercice commun et d'opinions parfois divergentes. Le personnel médical est souvent limité au seul médecin généraliste, même s'il ne manque pas de prendre l'avis d'un confrère si la situation s'y prête. Enfin, le médecin généraliste n'inscrit pas toujours sa décision explicitement sur le dossier médical. L'expérience rapportée par les médecins montre par ailleurs leur forte implication éthique. Contrairement à des situations bien définies et objets d'un relatif consensus, comme celle de l'arrêt et de la limitation des traitements actifs en réanimation, où des décisions collégiales peuvent être prises, le médecin généraliste, quant à lui, est confronté le plus souvent seul à des expériences diverses et hétérogènes en terme de limitation de traitement ou d'abstention thérapeutique à l'âge avancé. Si la particularité de la médecine générale est d'être un exercice de proximité avec le patient et la famille, la communication et la compréhension de ces personnes restent un enjeu. La réalité du terrain rend souvent une décision collégiale difficile. Le médecin généraliste aura peut-être à inventer des solutions spécifiques, pour lui permettre une pratique et une réflexion éthique moins solitaires. Les textes législatifs et les recommandations récentes concernant l'arrêt ou la limitation des soins en fin de vie sont des repères pour aider le médecin dans sa pratique, néanmoins, leur application sur le terrain reste un enjeu complexe.

Author: Sahra Gibbon
Publisher: Routledge
ISBN: 1134144725
Category : Health & Fitness
Languages : en
Pages : 387

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Biosocialities, Genetics and the Social Sciences explores the social, cultural and economic transformations that result from innovations in genomic knowledge and technology. This pioneering collection uses Paul Rabinow’s concept of biosociality to chart the shifts in social relations and ideas about nature, biology and identity brought about by developments in biomedicine. Based on new empirical research, it contains chapters on genomic research into embryonic stem cell therapy, breast cancer, autism, Parkinson’s and IVF treatment, as well as on the expectations and education surrounding genomic research. It covers four main themes: novel modes of identity and identification, such as genetic citizenship the role of institutions, ranging from disease advocacy organizations and voluntary organizations to the state the production of biological knowledge, novel life-forms, and technologies the generation of wealth and commercial interests in biology. Including an afterword by Paul Rabinow and case studies on the UK, US, Canada, Germany, India and Israel, this book is key reading for students and researchers of the new genetics and the social sciences – particularly medical sociologists, medical anthropologists and those involved with science and technology studies.

Author: Roy MacLeod
Publisher: Springer Science & Business Media
ISBN: 1402054904
Category : Science
Languages : en
Pages : 292

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This book represents a first considered attempt to study the factors that conditioned industrial chemistry for war in 1914-18. Taking a comparative perspective, it reflects on the experience of France, Germany, Austria, Russia, Britain, Italy and Russia, and points to significant similarities and differences. It looks at changing patterns in the organisation of industry, and at the emerging symbiosis between science, industry and the military.

Author: Gerhard Neuner
Publisher: Council of Europe
ISBN: 9789287151704
Category : Language Arts & Disciplines
Languages : en
Pages : 152

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Author: Ian McKellen
Publisher:
ISBN: 9781692648305
Category :
Languages : en
Pages : 608

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Everybody loves secrets. We're all fascinated by celebrities, the rich, the powerful, and the famous. When scandals break out we want to read all about it. And the surest way to get anyone's attention is to start talking about sex. Now there's a book that has all this and much more, with over 900 amazing stories about prominent people from ancient Egypt to today who, in their personal lives, all had one thing in common. They were all gay, lesbian, or bisexual. Movie stars, musicians, kings, queens, soldiers, athletes, scientists, and even religious leaders from all over the world. The book is called Queers in History. It's a funny title and definitely a fun read. But there's also tons of serious useful information revealing a secret side of these famous personalities. Queers in History reveals the compelling stories about some of your favorite folks that are usually left out of their official biographies. Did you know that, for instance: * Joan Crawford and Marilyn Monroe had a one-night-stand? * Leonardo da Vinci was imprisoned twice for same-sex affairs? * Leonard Bernstein had an affair with an Israeli soldier? * The lesbian wife of a gay actor accused Howard Hughes of having an affair with her husband shortly before his mysterious murder? * The founder of Shinto Buddhism also founded a tradition of male-male love in Japan? * Angelina Jolie wanted to marry her "Firefox" co-star Jenny Shimizu? * The wife of one US president moved her girlfriend into the White House, and another US President shared his White House bed with the male chief of his security detail? * An heroic soldier in the US Revolution was actually a woman in disguise, who "married" another woman after her service in the Continental Army? * And in 1886, when US officials asked an Indian tribe to send "their best woman" to visit Washington, DC, the tribe chose instead to send a man in a dress?These are just a few of the historical facts you'll learn from Queers in History. It took 17 years to gather the information that fills over 500 pages in this trade paperback. One of the most amazing facts is that Queers in History is only $13.67 if you pre-order on Amazon.com . That's a lot less than a penny per fact, all from reliable sources.But Queers in History is much more than a collection of facts. Each person's life is presented as an entertaining short story, showing how their sexuality affected their lives and their work. And though it's about gay people, it's something everybody will be interested in, especially straight people who may not know as much as they think they do about some of their favorite celebrities. The previous edition got rave reviews in USA Today, Wired magazine, The Village Voice, and many others.Put this book on your coffee table before your next party and a few minutes later it will be the main topic of conversation. Just don't put it in the bathroom because the first person in there may lock the door and not come out until they've finished reading it. My name's Keith Stern, I wrote Queers in History, and I've produced some of the most popular biographical websites on the Internet. Sir Ian McKellen, better known as Gandalf and Magneto in the movies, has contributed an inspirational foreword to the book. Visit www.queersinhistory.com for more information.

Author: H. L. P. Resnik
Publisher: Brady Publishing
ISBN:
Category : Psychology
Languages : en
Pages : 204

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Author: Wataru Walter Sutow
Publisher:
ISBN:
Category : Medical
Languages : en
Pages : 982

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Author: Eric Von Hippel
Publisher: MIT Press
ISBN: 0262250179
Category : Business & Economics
Languages : en
Pages : 224

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The process of user-centered innovation: how it can benefit both users and manufacturers and how its emergence will bring changes in business models and in public policy. Innovation is rapidly becoming democratized. Users, aided by improvements in computer and communications technology, increasingly can develop their own new products and services. These innovating users—both individuals and firms—often freely share their innovations with others, creating user-innovation communities and a rich intellectual commons. In Democratizing Innovation, Eric von Hippel looks closely at this emerging system of user-centered innovation. He explains why and when users find it profitable to develop new products and services for themselves, and why it often pays users to reveal their innovations freely for the use of all.The trend toward democratized innovation can be seen in software and information products—most notably in the free and open-source software movement—but also in physical products. Von Hippel's many examples of user innovation in action range from surgical equipment to surfboards to software security features. He shows that product and service development is concentrated among "lead users," who are ahead on marketplace trends and whose innovations are often commercially attractive. Von Hippel argues that manufacturers should redesign their innovation processes and that they should systematically seek out innovations developed by users. He points to businesses—the custom semiconductor industry is one example—that have learned to assist user-innovators by providing them with toolkits for developing new products. User innovation has a positive impact on social welfare, and von Hippel proposes that government policies, including R&D subsidies and tax credits, should be realigned to eliminate biases against it. The goal of a democratized user-centered innovation system, says von Hippel, is well worth striving for. An electronic version of this book is available under a Creative Commons license.

Author: Marjorie A. Bowman
Publisher:
ISBN:
Category : Medical
Languages : en
Pages : 420

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Inside, you'll find practical information on how to handle the most common emergencies that present in primary care offices and urgent care centers -- whether in person or over the telephone.