Search PubMed⌕ Search

Biomedical subjects

B Lachaux

Publications and source records attributed to B Lachaux.

13 recordsLinked to original sources
PubMed2000

Assessing the impact of a consensus conference on long-term therapy for schizophrenia.

OBJECTIVE: Our aim was to assess the impact of six recommendations regarding drug prescription on the clinical practices of French psychiatrists. The recommendations were part of the conclusions of a consensus conference entitled "Long-term therapy of schizophrenia" (Paris, January 1994). METHODS: The impact of the conference was assessed on the basis of awareness of the existence of the conference, knowledge of its conclusions, and actual changes in clinical practice. We performed: a) a survey of a representative sample of 396 psychiatrists 2 years after the conference; and b) an analysis of changes in drug prescriptions in a cohort of 2,407 patients with schizophrenia under treatment at the time of the conference. RESULTS: Overall, 78% of interviewed psychiatrists were aware of the existence of the conference and 70% of its conclusions. Declared prescription practices conformed with conference conclusions about 60% (10%-95%) of the time. No difference in practices was noted between psychiatrists who were aware of the recommendations and those who were not. Single neuroleptic prescriptions increased in the cohort study in line with the main conference recommendation. The increase was small, but significant from 51.1% to 56.4%, and mainly concerned patients recently put on treatment. Contrary to recommendations, prescriptions of anticholinergics plus neuroleptics inexplicably rose from 48.2% to 54.3%. CONCLUSION: Small changes in prescription habits occurred in the wake of the consensus conference, but we cannot really ascribe them to a direct impact of the conference. Despite the great pains we took in disseminating the conclusions of the conference as widely as possible, it is clear that a more forceful action plan (e.g., including continuous medical education) is required.

Adolescent↗
PubMed1998

[Legislative and ethical aspects of drug experimental in children and adolescents].

Experimentation of drugs in children meets with ethical and legal difficulties. After studying historical development of drug trials regulation, the different ways to define the modalities of clinical trials (law, technical aspect, deontology, ethics) are described. The importance of the informed consent and its particularities when children are concerned are emphasized. Finally, it appears ethical and necessary to practice drug trials in children in order to obtain safe and efficient drugs and prescriptions in pediatrics.

Adolescent↗
PubMed1997

[A new study of secondary effects in prescribing practices of neuroleptics].

Within the context of our knowledge of the neuroleptics, side-effects have not only been considered for a number of years as an unavoidable element of these agents; they in fact practically constitute a defining feature of such drugs. Advances in knowledge and the availability to prescribing practitioners of so-called "atypical" neuroleptics allow some redefinition of the above problem. A multidimensional approach which goes beyond more nosographic considerations, and the addition of a temporal dimension to a question for too long reduced to its spatial aspect are new elements which help put the issue of side-effects in perspective. However, any examination of this subject must also take into account the quality of life and the subjective experience of patients undergoing treatment with neuroleptics, since these considerations represent important pathways for the future. Such analysis must also take into account the current situation, in which excessive prescription of corrective agents, the prevalence of co-prescription of psychotropic agents and wide variations in prescribing of neuroleptics (for too long overlooked, in terms of both analysis and education) have given rise to coercive control strategies. The system of Opposable Medical References (OMR) forms part of a panoply of measures aimed at control rather than education. However, education constitutes a key element in this field if the goal of re-appropriation is to be achieved.

Antipsychotic Agents↗
PubMedDate not supplied

[The study of the impact of the consensus conference "Strategies for long-term therapy of patients with schizophrenia"].

UNLABELLED: The case management, treatment and psychosocial rehabilitation of schizophrenic patients is an important part of the activity of the psychiatric sector and takes up many human, scientific, organizational and financial resources. The best way to reach satisfactory results for the individual patient is still uncertain and current practice in France shows noticeable variations that have been rarely investigated in terms of outcome. A consensus conference (CC) on "Strategies for long-term therapy of patients with schizophrenia" was therefore held in Paris in 1994 to produce accurate guidelines designed to help both clinicians and patients and to improve practice. It was organized by the French Federation of Psychiatry, the National Union of Friends and Relatives of Mental Patients, and the National Agency for the Development of Health Evaluation. The conclusions of the CC were mailed, in the form of a booklet, to members of these associations (psychiatrists and relatives) and were reported in the medical and general press. METHODS: The impact of the CC was judged by (a) the psychiatrists'awareness of the existence of the CC, (b) their knowledge of its conclusions, and (c) changes in practice. The following were analyzed: press coverage; requests for the booklet; the results of a survey of a representative sample of 396 psychiatrists two years after the CC; prescription changes in the public sector in a cohort of 2,407 schizophrenic patients under treatment at the time of the CC; prescriptions to psychotic patients by a representative sample of psychiatrists in private practice. RESULTS: Awareness: Articles on the CC were published in 27 journals and newspapers, 30,000 booklets were distributed and 8,348 were mailed in response to 1,121 spontaneous requests; 78% of the psychiatrists interviewed said they were aware of the existence of the CC and 70% said they were aware of the conclusions. Knowledge: The psychiatrists' declared practice conformed with CC conclusions 41%-85% of the time depending on the recommendation. No difference in practice was noted between the psychiatrists who said they knew of the recommendations and those who said they did not. Changes in practice: A significant but small improvement in prescription habits was noted for a principal recommendation ("just one neuroleptic is enough"). One-neuroleptic prescriptions increased from 51.1% the year before the CC to 56.4% two years after the CC. The increase mainly concerned the most recently treated patients. However, during the same time-span, prescriptions of anti-cholinergics plus neuroleptics rose from 48.2% to 54.3%. CONCLUSION: It is difficult to attribute changes in practice to a CC. However, the impact of the CC seemed real even if inconstant and not great enough. Clearly, to enhance impact an action plan is needed. It should include corrective measures and focus on additional dissemination efforts, teaching and training programs, and updating of guidelines if necessary.

Adult↗
PubMedDate not supplied

[Between compliance and freedom: the patient's statement].

According to the patient, obtaining a good compliance is related to a good relationship with his practitioner; this relationship is directly connected to being a good listener for the patient, and not only for their symptoms. If the individual motivation is very important at the beginning, it will be itself greatly influenced by the relationship between the practitioner and the patient. It is one of the rare factors with a positive correlation with compliance, that's what almost all of the researches on medical psychology have observed. Once the problem is sumed up, it's the turn to speak for the patient, who explains how he considers compliance.

Freedom↗
PubMedDate not supplied

[About ethics in psychiatry and psychiatrists facing ethics].

The plug in account of the suffering, notably psychological, in a consultation, puts the problem of the relationship between suffering and ethics. However, the originality of the ethical step is justly not to be confined to the social norm conformism, but being specific to the individual dimension. The psychiatric pathology offers in this area of particularities interesting. The neurotic, as the obsessed, suffering inwardly pathological manifestations that he judges absurd, replies to the medical moral in asking a care. The psychotic, which projects his suffering on the other, does not feel sick, requests no therapeutic assistance. As such he contests the medical order in an immoral position by definition, and the patient represents from then on a social and medical scandal. In front of a such clinical diversity, we can easily underline that approaching the theme of ethics in psychiatry isn't a well-off exercise, and necessitates a precise locating registered in the history of the patient.

Ethics, Medical↗
PubMedDate not supplied

[The need for a law concerning human body rights].

This new "turn of the century", at least in France, is marked by an increasing discrepancy between laws and new medical discoveries. Medical practitioners, scientists and researchers have had such a fantastic power and, as a consequence, the patients have never run such an important risk of loosing human dimensions. The basic question is the legal status of the human body. Until now, common law considers human being as a citizen whose liberty should be limited under certain conditions. However, this point of view poorly prepares to rule man as a creature of flesh and sentiment. There is an almost complete deficit of the legal statute of man in his globality, especially concerning the juridical status of the human body which is totally lacking as a whole in the french civil code. Human body represents a double legal problem: is its integrity a private or a public privilege? Are his dignity and identity really warranted for everyone?

France↗
PubMedDate not supplied

[Processing of nominal data for research purposes: a new text].

The automated processing of nominal data is now governed by the 1st July 1994 law and its application decrees. This new procedure that situates between emphasis of the control and attenuation of the secret professional adds to others already existent. France has now a complete device and it is necessary to articulate this text with the other references concerning biomedical research, notably the 20 December 1988 law told Huriet law. The new social risks of the biomedical research pose the questions of separation of the care and the research in medicine confirmed by this new legislative text and that of the look of the social body on the research. This work aims to favour the comprehension of the context and the knowledge of these judicial references as well as its professionals integration.

Computer Security↗
PubMedDate not supplied

[Consent: between legality and legitimacy or between "formal" and "informed" consent].

As shown by a recent decree of the supreme court, the legal aspect of information given before consent is more and more important. At beginning, the written consent was reserved to particular cases, as biomedical research for example. It concerns now all the fields of care, since it is considered as a proof of the existence of a prior information. The informed consent changes in a formal consent: the consequence is a modification of the relation between the physician and the patient. We may imagine that this evolution paradoxically results in a worse integration of subjectivity. Then, it seems necessary to stress the clinical aspect so as to give to the consent concept its legitimity back: it consists in an ethical and humanistic acknowledgement of alterity.

Ethics, Medical↗