Dissertations / Theses on the topic 'Maladies professionnelles – Patients'
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Leroy, Chloé Bellemère Philippe. "Devenir socioprofessionnel des patients opérés d'une épicondylalgie à propos de 82 cas /." [S.l.] : [s.n.], 2007. http://castore.univ-nantes.fr/castore/GetOAIRef?idDoc=19431.
Dutreuil-David, Nathalie. "Adénocarcinome de l'ethmoi͏̈de : étude rétrospective de 63 patients." Bordeaux 2, 1999. http://www.theses.fr/1999BOR23020.
Bègue, Cyril. "Prise en charge des problématiques de santé au travail par le médecin généraliste." Electronic Thesis or Diss., Angers, 2023. http://www.theses.fr/2023ANGE0045.
General practitioners are frequently confronted with patients presenting occupational health problems. The aim of this thesis was to explore this type of care by documenting practices, to help improving practices by designing an educational resource, and to help producing contextualised data by proposing a research protocol. The study confirmed that GPs frequently prescribe sick leave. The prescription rate varied according to gender, age, socioprofessional category and length of consultation. The frequency of use of two return to work tools (pre-return-to-work medical consultation and therapeutic part-time work) and the frequency of contact with the occupational physician were satisfactory, although not optimal. A book chapter was written to document the role of the general practitioner in dealing with these problems, while also providing a training resource. Finally, a protocol was proposed for a complex intervention designed to improve the management of psychological suffering at work, based on 4 axes : training of GPs, rapid referral to the occupational physician, prescription and extension of sick leave and close follow-up
Delrieux, Anne-Emmanuelle Leroux Gérard. "Quelles compétences les femmes enceintes attendent-elles du praticien qui suit leur grossesse ? enquête dans une maternité du Val-de-Marne auprès de 241 patientes /." Créteil : Université de Paris-Val-de-Marne, 2006. http://doxa.scd.univ-paris12.fr:80/theses/th0245052.pdf.
Gagné, Myriam. "Outiller les éducateurs en santé respiratoire : Retombées pour les professionnels et pour les patients." Doctoral thesis, Université Laval, 2019. http://hdl.handle.net/20.500.11794/66755.
Background: There is a need to enhance self-management support (SMS) provided by respiratoryeducators to patients with asthma or chronic obstructive pulmonary disease (COPD) and to developa training model targeted at respiratory educators. To this end, our objectives are to measure 1) theimpact of using a patient decision aid (DA) as part of an SMS session in regard to asthmaknowledge and control among adults with asthma and 2) the educational outcomes associated witha training session on SMS and targeted at respiratory educators in regard to a) educators’competence and knowledge of SMS and b) COPD patients’ quality of life and hospitalizations.Methods: Objective 1. We conducted a randomized parallel clinical trial and randomly allocatedadults with asthma either to the education-only or education+DA group. Patients from both groupswere provided with SMS. In the education+DA group, patients filled a DA on inhaled maintenancemedication. Before and two months after the interventions, patients filled validated questionnairesmeasuring asthma knowledge (Questionnaire de connaissances sur l’asthme de langue française,score -37-37) and asthma control (Asthma Control Scoring System, score 20-100). We used linearmixed models to estimate change in scores within and between groups. Objectives 2a and 2b. Weconducted a before-and-after study using mixed methods. Respiratory educators attended a 7-hourlecture-based training session on COPD-specific SMS. Before the training session and afterwards,educators filled standardized questionnaires measuring their competence in providing SMS (score1-10) and their knowledge of SMS (score 0-25). Four months after the training session, werecruited patients with COPD who were provided with SMS by a newly trained educator. BeforeSMS and six months later, patients completed a validated quality of life questionnaire (St. George'sRespiratory Questionnaire, score 0-100) and reported whether they had been hospitalized in thelast six months. We used mixed linear or log-binomial models to estimate changes in scores orproportions. Five months after the training session, interviews were conducted with the educators.Verbatim were qualitatively analyzed to further explain our quantitative results.Results: Objective 1. We recruited 51/96 people with asthma (mean age: 44±13 years, women:n=32), who were allocated to the education-only (n=25) or education+DA group (n=26). In bothgroups, the mean asthma knowledge score and the mean asthma control score improved after viinterventions. Improvements in asthma knowledge and control were not different between groups.Objective 2a. We recruited 43/43 educators who attended the training session. The mean score ofcompetence in providing SMS improved after the training session (before: 5.5/10; after: 8.3/10;P<0.0001), as did the mean score of knowledge of SMS (before: 10.0/25; after: 14.3/25;P<0.0001). Objective 2b. We recruited 54/75 COPD patients (mean age: 69±8 years, women:n=23) who were provided SMS by a newly trained educator. The mean quality of life scoreimproved after SMS (before: 41.5/100, after: 28.7/100, P=0.0001). The number of patients whowere hospitalized was not different before and after SMS. Our qualitative results confirmed ourquantitative results.Conclusions: Our results suggest that SMS, with or without DAs, improve asthma knowledge andasthma control. The participation of respiratory educators in a lecture-based training session onSMS is associated with improvements in educators’ competence to deliver SMS, educators’knowledge of SMS, and COPD patients’ quality of life, but does not seem to have an effect onhospitalizations. Both strategies used to enhance SMS can be further improved – e.g. the DA couldbe used during several SMS sessions and active learning activities could be incorporated duringthe training session – to maximize their impact.
Penchaud, Anne-Laurence. "En quête d'un style : la socialisation professionnelle des internes en psychiatrie." Bordeaux 2, 2007. http://www.theses.fr/2007BOR21456.
Porchy-Simon, Stéphanie. "Volonté du malade et responsabilité du médecin." Lyon 3, 1994. http://theses.univ-lyon3.fr/documents/lyon3/1994/porchy_s.
Kasbi-Benassouli, Valentine George Caroline. "Étude du devenir médical et socioprofessionnel des patients adressés pour souffrance psychologique au travail à une consultation de pathologie professionnelle." Créteil : Université de Paris-Val-de-Marne, 2006. http://doxa.scd.univ-paris12.fr:80/theses/th0247835.pdf.
Lancelevée, Camille. "Quand la prison prend soin : enquête sur les pratiques professionnelles de santé mentale en milieu carcéral en France et en Allemagne." Paris, EHESS, 2016. http://www.theses.fr/2016EHES0101.
While Germany relies on forensic hospitals (MaBregelvollzug) since the 1930s, the French penal system develops mental health care services from the 1980s in order to deal with inmates with mental disorders. The involvement of mental health professionals in the penal system begs the question of hybridization of care and punishment. The aim of this thesis is to investigate this hybridization in a French-German comparative. Based on ethnographic field studies - carried out respectively over five months in a French and German prison - the thesis examines the various arrangements of care and punishment: while the prison of Tourion (France) can be described as a fragmented institution, in which the lines between penitentiary and mental health care services are demarcated, the prison of Grunstadt (Germany) arranges a reinforced cooperation. In both countries, however, the presence of mental health care professionals leads to ambivalent effects: it brings the mental suffering of inmates into the spotlight, but also contributes to the legitimization of the concept of therapeutic punishment -life sentence as therapy for the most "dangerous" inmates. Ultimately, this thesis illustrates the contemporary transformations of the prison to an "asylum", namely a place where punishment and treatment are intertwined, but equally, one of the last refuges for certain forms of madness. Beyond prisons, this thesis contributes to analyzing the relation between institutional transformations and the evolution of professional worlds
Roche, Stéphanie. "Conseil au patient en fin d'hospitalisation : une implication du pharmacien hospitalier dans la prévention de l'iatrogénie médicamenteuse." Reims, 2008. http://www.theses.fr/2008REIMP054.
Baugier, de Materre Alix. "L’éducation à l’autonomie est-elle possible lors de l’éducation thérapeutique du patient dans les maladies chroniques ?" Thesis, Paris 10, 2019. http://www.theses.fr/2019PA100059.
Therapeutic patient education is an important part of the management of the patient with chronic disease. Therapeutic education is a structured process whether in its conception or in its modes of realization. What the patient must remember is in the form of skills to acquire. The skills represent the abilities that the patient puts into play in the management of his chronic disease. These skills are of two kinds: "self-care" skills, and "adaptive" skills. During this work, we will focus more specifically on what corresponds to so-called adaptation skills, and more particularly to the possibility of patient autonomy in the management of his pathology. From a methodological point of view, we will achieve a historical and theoretical focus on therapeutic education. An upstream ethical reflection on the concept of autonomy will be accompanied by a reflection from the practice. We will also rely on a detailed analysis of a survey. The objective of this work will be to reflect on improvements in the field of training and patient care
Denis, Michel R. "Le devoir de dénoncer des professionnels de la santé : du droit des patients à la vie privée au droit des tiers à la vie." Sherbrooke : Université de Sherbrooke, 1998.
Ponthier, Nathalie. "Les réseaux de santé : espaces de cooperation entre professionnels et patients : étude comparative de deux reseaux de sante diabète." Thesis, Lyon 2, 2012. http://www.theses.fr/2012LYO20013/document.
The law of March 4th 2002 concerning patients' rights and the quality of the care system formalizes health networks and provides a single definition. They now account for an organizational form registered in regional politics of public health and are financially supported by the regional health agencies (RHA). The conducted research is about the sick's participation in a health network operation and activity. Indeed, if the legislation grants the user a thorough place in the health care system and if health policy proclaims his participation, what happens in the daily reality of practices within a health network? So this research deals more specifically with the interactions between professionals and users by considering the network as an area of cooperation. The comparative study of two Burgundy diabetes health networks shows how - facing a double constraint, those of public health policies and that of a dominant economic regulation - this device is subject to a managing logic leading to become an instrumental response to health system dysfunctions, such as multiple barriers of the health system, a demographic shortage of health professionals or even an increasing medical specialization of health activities. But even these networks constitute an experimental space favorable to the implementation of a community health practice.The data base has mainly been formed from 31 biographical interviews of diabetic people, thematic interviews of professionals employed in networks and observations of the patient's therapeutic education practices, a service offered by the two networks. This service examines the possible ways of working together in the management of chronic illness between professionals and the sick. According to the conceptions of health among professionals and logic of action involved, the study shows two trends: a sick person, either partner in patient care or in care giving.Moreover, the studied networks present two different organizational terms, a linear model and a satellite model where the coordination of actors plays a major role. Behind this term of coordination lies, in both cases, a principle of rationalization of health activities specific to the current health system. Networks are thus subject to an economic exploitation; they become providers of the offer of health care in a given territory. This instrumentation of health networks is mainly implemented by assessment procedures. It relies on epidemiological data and is based on a quantitative approach about health outcomes. In a managerial logic, the sick person should behave in accordance with health standards to enable the achievement of organizational goals planned as part of a public health policy.With the development of chronic diseases, the field of health has changed, but the French health system is still organized on a biomedical logic. The evaluation is based on normative biomedical knowledge, and professional practices are also very much imbued with biomedical logic. Nevertheless, the study shows that networks create a favorable space for a community health practice by creating a social proximity. Both networks put into perspective the idea that users have a hold on questions concerning their health. Patients and professionals become actors besides operational objectives displayed in a health network. Thus, networks are simultaneously democratic spaces of thought and a tool dedicated to the efficiency of health activities
Sohi, Julia. "Favoriser la communication entre les professionnels de la santé, le patient et ses proches dans le processus de choix de soins en contexte de maladie grave : planification d'une intervention dans le cadre d'une recherche-action." Mémoire, Université de Sherbrooke, 2011. http://hdl.handle.net/11143/5961.
Pouteau, Cécile. "Expérience du geste intracorporel : l'expérience des infirmières en interaction avec un malade dans le cadre d'un soin prescrit." Thesis, Paris, CNAM, 2018. http://www.theses.fr/2018CNAM1212/document.
This thesis is all about the mental activities realized during an invasive gesture of a nurse on a patient. It deals with the question what makes the nurse to consider as an object the patient’s body wheras the new pedagogies advocate turning a sick person actor of his own care. The aim of this study is to characterize the intellectual path imposed by this gesture in terms of operational effectiveness and motivation to act. It is about solving the tensions between what the nurses think they have to do – with regards to their prescription and professional recommendations – and what they really can do in situation
Thiam, Yacine. "Comprendre le vécu et les ressentis des patients chroniques à la suite d'un [programme] d'éducation thérapeutique en court séjour : le cas des patients cardiovasculaires du CHU Clermont-Ferrand." Thesis, Clermont-Ferrand 1, 2012. http://www.theses.fr/2012CLF1MM14/document.
The professionals of the practice analysis and care organization take part in a complex system where biological, cultural and social factors interact. This research task focuses on the experiences of the cardiovascular patient entering a therapeutic education program, after an acute event (myocardial infarction or stroke). It is justified by the need to understand the phenomenon of recurrence, relapse and hospitalization returns despite an informative and educational treatment in cardiovascular risk factors (smoking, physical inactivity, poor nutrition) during the initial hospitalization. Our main goal is therefore to understand these recurrences, relapses and hospitalization returns of cardiovascular patients other than the result of non-compliance. This qualitative research is carried out at the University Hospital Center of Clermont-Ferrand (Cardiology Department short stay) and at the cardio-pneumologic clinic of Durtol (follow-up and rehabilitation care center). The research is based on 22 observation situations of professional practices, nine focused interviews with professionals in these two sites above and 31 semi-structured interviews with the patients. These surveys are supplemented by an analysis of the French and Anglo-Saxon literature in the field of therapeutic education, compliance and behaviours change. In terms of results, the research presents the recurrences, relapses and returns to patients' short stay hospitalization as the result of an inappropriate care to their needs. Time discrepancies, experiences and felt between health professionals and patients during the initial hospitalization, inadequate structural short stay, the discontinuity of care and the inconsistencies in accordance with different levels of complexity (short stay, follow-up and rehabilitation care center and at the attending physicians', but mostly the confusion between the patient's education and the patient's information, makes medical and nursing requirements in terms of the change of risky behaviours hardly observable by patients. The current format of the relationship and the interactions patient/health professionals during the care doesn't promote the involvement and the active participation of patients in their care. In conclusion we retain that the elements which influence the patients' behaviours with respect to their treatments do not only depend on training, but on their experiences and felts and also on their interactions with health professionals. The informative and educational care of the risk factors sometimes conceals the relational aspect of this therapeutic and the cognitive and emotive capacities of the patients. It should follow a double evolution: that of the patient (his emotions, his expectations, his life plans) and that of the pathology. This work also seeks to answer to the following question: why and how a socio- anthropological approach allows us to understand the patients' behaviours on one hand and the health professionals on the other hand in a context of PTE (patient's therapeutic education) in short stay? It argues for a reconnection between social sciences and medical and nursing in the French health care system and shows the significant contribution but still too little used by social sciences in this area
Fortin, Gabrielle. "Élaboration et évaluation d’une stratégie d’application des connaissances pour les professionnels de la santé sur la détermination des objectifs de soins avec les personnes malades." Doctoral thesis, Université Laval, 2020. http://hdl.handle.net/20.500.11794/67446.
Goals of care conversation (GOCC), a process which consists in identifying with patients the appropriate care for their health condition in accordance with their life plan, is arguably one of the most difficult decisions patients with serious illnesses will face. GOCC implies discussion between the physician and the patient (or his Substitute Decision Maker). It is often complex, since the preferred care orientation for patients must consider their health situation while being consistent with their beliefs, preferences and values as well as those of their relatives. To address these complex situations, the contribution of an interprofessional team is required to support patients in their global perspective. There is, however, a gap that needs to be filled amidst interdisciplinary teamwork in order to integrate GOCC discussions in the routine of care teams so that GOCC no longer rely solely on discussions between the physicians and their patients. In order to reduce this gap, a knowledge transfer strategy aimed at optimizing interprofessional collaboration practices in GOCC situations with the participation of the patients and their relatives was proposed. Co-constructed and deployed in a clinical environment in collaboration with health and social services providers, the knowledge transfer strategy was evaluated in three successive phases, either at the time of its development, during its implementation and finally, after this in order to assess the impact on clinical practices. Twenty-six healthcare providers from different disciplines practicing at the CHU de Québec- Université Laval and at the CIUSSS de la Capitale-Nationale took part in the knowledge strategy, which main activity was the interprofessional training session held during Winter 2018. Analysis of collected data during development and implementation phases highlights : 1) relevance in mobilizing the various players targeted by the knowledge transfer strategy in order to develop relevant content that takes into account the needs and realities in practice context; 2) the need to obtain support from the management of establishments to facilitate the deployment of this type of initiative in health care and health services environments; 3) the importance of fostering a climate of openness and discussion spaces during interdisciplinary training session to promote the appropriation of interprofessional competencies, as well as a place conducive to the development of critical reflections on the participants' GOCC practice. The highlights of the short-term impact assessment phase of the strategy emphasized three main changes observed by the participants in their GOCC practice: 1) better appropriation of a harmonized level of care form for discussing end-of-life issues with patients; 2) improved IPC practices in complex GOCC situations through better affirmation of their expertise role along with recognition of other professionals’ role in this decision-making process, and 3) reaffirmed roles of advocacy, support and enabler with patients and families in GOCC context. In light of these results, recommendations are made to optimize the timely participation of sick people in informed decision-making processes about their end-of-life care, this in an interprofessional collaboration perspective. Recommendations related to the provision of earlier support services in the care trajectory of patients with serious illness, with a potentially fatal outcome in order to facilitate dialogue between patients and stakeholders in anticipation of end-of-life are also presented. This thesis concludes by proposing avenues to be explored in research.Goals of care conversation (GOCC), a process which consists in identifying with patients the appropriate care for their health condition in accordance with their life plan, is arguably one of the most difficult decisions patients with serious illnesses will face. GOCC implies discussion between the physician and the patient (or his Substitute Decision Maker). It is often complex, since the preferred care orientation for patients must consider their health situation while being consistent with their beliefs, preferences and values as well as those of their relatives. To address these complex situations, the contribution of an interprofessional team is required to support patients in their global perspective. There is, however, a gap that needs to be filled amidst interdisciplinary teamwork in order to integrate GOCC discussions in the routine of care teams so that GOCC no longer rely solely on discussions between the physicians and their patients. In order to reduce this gap, a knowledge transfer strategy aimed at optimizing interprofessional collaboration practices in GOCC situations with the participation of the patients and their relatives was proposed. Co-constructed and deployed in a clinical environment in collaboration with health and social services providers, the knowledge transfer strategy was evaluated in three successive phases, either at the time of its development, during its implementation and finally, after this in order to assess the impact on clinical practices. Twenty-six healthcare providers from different disciplines practicing at the CHU de Québec- Université Laval and at the CIUSSS de la Capitale-Nationale took part in the knowledge strategy, which main activity was the interprofessional training session held during Winter 2018. Analysis of collected data during development and implementation phases highlights : 1) relevance in mobilizing the various players targeted by the knowledge transfer strategy in order to develop relevant content that takes into account the needs and realities in practice context; 2) the need to obtain support from the management of establishments to facilitate the deployment of this type of initiative in health care and health services environments; 3) the importance of fostering a climate of openness and discussion spaces during interdisciplinary training session to promote the appropriation of interprofessional competencies, as well as a place conducive to the development of critical reflections on the participants' GOCC practice. The highlights of the short-term impact assessment phase of the strategy emphasized three main changes observed by the participants in their GOCC practice: 1) better appropriation of a harmonized level of care form for discussing end-of-life issues with patients; 2) improved IPC practices in complex GOCC situations through better affirmation of their expertise role along with recognition of other professionals’ role in this decision-making process, and 3) reaffirmed roles of advocacy, support and enabler with patients and families in GOCC context. In light of these results, recommendations are made to optimize the timely participation of sick people in informed decision-making processes about their end-of-life care, this in an interprofessional collaboration perspective. Recommendations related to the provision of earlier support services in the care trajectory of patients with serious illness, with a potentially fatal outcome in order to facilitate dialogue between patients and stakeholders in anticipation of end-of-life are also presented. This thesis concludes by proposing avenues to be explored in research.
Farhat, Mounir. "Le travail du care : entre engagement et distanciation. La relation entre professionnels et résidents au sein des unités Alzheimer." Thesis, Paris Sciences et Lettres (ComUE), 2017. http://www.theses.fr/2017PSLED054/document.
In France, since early 2000s spreads a literature inviting professionals in contact with people suffering from Alzheimer disease to "personalize" the way they take care of them. This term refers to a humanization that seems to fade away in this particular context. What is asked to medical and paramedical staff, is a true and authentic commitment toward these patients. What is aimed, is a control of emotions and the way they are expressed.This Ph.D explores the way in which "personalization" is practically accomplished in the context of Alzheimer’s Special Care Units. Based on interviews and observations, it shows the banality of "commitment", and also the complexity of it’s execution. From the ethics of care perspective, an invisible work makes life possible for every protagonist living in that kind of environment. This cleverness of the situation drives away the danger of reification, and prevents burnout.Far from the chimerical "professional distance", this field work shows an articulation between commitment and detachment (Elias, 1956). Emotions appears to be a necessity in order to carry out the tasks, but also a danger that requires to be put away. Thus, Alzheimer’s units are characterized by the relative importance of autonomous regulation, in comparison with control regulation (Reynaud, 2004) : formalization process struggle due to the elusive and local nature of the ethics of care
Gourdin-Petit, Le Manac'h Audrey. "Interaction entre les parcours de soins et les parcours professionnels des lombalgiques. : Rôle de la coordination des acteurs de soins et de la prévention. Low back pain, intervertebral disc and occupational diseases Recommandations de bonnes pratiques pour la surveillance me´dico-professionnelle du risque lombaire pour les travailleurs expose´s a` des manipulations de charges Pre‑employment examination for low back risk in workers exposed to manual handling of loads: French guidelines French good practice guidelines for medical and occupational surveillance of the low back pain risk among workers exposed to manual handling of loads. Pre-return-to-work medical consultation for low back pain workers. Good practice recommendations Chronic low-back pain, chronic disability at work, chronic management issues." Thesis, Angers, 2015. http://www.theses.fr/2015ANGE0092.
Low back pain is a major public and occupational health issue in industrialized countries. Chronic low back pain and resulting disability are potential sources of impaired quality of life, breaking career and even socio-professional exclusion. The first part of this work places the issue of the back intervertebral disc disease related to work and its social recognition.The low back pain chronicity and the social and professional restriction of participation are part of a dynamic model involving factors related to the individual, to the prevention and care system, to work, and to the financial compensation system. The need for integration of all these elements for medical care, prevention and medical and occupational surveillance of low back pain workers is developed through the presentation of recommendations for good practice. Recommendations for pre-return-to-work medical examination especially emphasize the benefit of coordinating medical, social and occupational actors for the return to / retention at work and the fight against occupational exclusion of low back pain workers. Finally, the offered to low back pain workers strategies which have shown their effectiveness in reducing the duration of sick leave combine an intensive physical rehabilitation, a cognitive-behavioral approach, a workplace intervention and the coordination of return to work actors. However, the implementation of these complex interventions has a great number of limitations
Cammellini, Céline. "Les médecins et les patients face à la fin de vie : entre devoir thérapeutique et volonté de choisir sa mort." Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM1018.
During the last century, the circumstances of the death changed. Most of the deaths arise now at high ages even very high. They mainly take place in institution and are often preceded by a long chronic disease accompanied with sufferings and with fears which cannot be relieved. The same feelings also find themselves at the more or less young people, damaged by the life.That is why, from now on, the patients favor the quality of the death to the extra time of the life in the suffering. So, more and more frequently, the medical profession is confronted with requests of euthanasia or suicide assisted on behalf of the suffering.It is in this context that it is interesting to wonder on the French legislation regarding the end of life and on the place given as long to the healthcare professionals, and the patients.If the Leonetti’s law of April 22nd, 2005 constituted a considerable advance on the subject, she does not unfortunately answer all the existing situations and currently not sufficient in front of constant requests of the suffering people and the majority of the French population. The recent affair Vincent Lambert shows it in which, the medical team confronted with clashing notices within the family close to the patient and in the absence of will expressed by this one, was brought to make a collective decision on the pursuit or not of the treatment delivered to this patient tetraplegic in state of minimal consciousness, who it seems did not want to survive any more. Followed itself several judicial scrums which allowed to boost the debate on the evolution of the legislation regarding the end of life