Franck Zenasni

Quality of Life of Patients Operated on for Low Rectal Cancer: Impact of the Type of Surgery and Patients’ Characteristics

PURPOSEThis study was designed to compare the impact of a permanent colostomy and sociodemographic characteristics on the quality of life of patients operated on for low rectal cancer.METHODSA cross-sectional study was performed by use of the European Organization for Research and Treatment of Cancer QLQ-C30 and CR-38 questionnaires. Patients came to the hospital to fill out the self-administered questionnaire or were sent the questionnaire by mail, followed by a live or telephone interview. All patients had undergone one of four operations: low anterior resection with colorectal or coloanal anastomosis (non-stoma group), or abdominoperineal resection with pseudocontinent perineal colostomy (nonstoma group) or left lower quadrant colostomy (stoma group).RESULTSA total of 132 patients were included for analysis and there were no missing data. For the majority of quality of life scores (26/29), there was no significant difference between stoma and nonstoma patients. However, stoma patients complained of diminished body image (P = 0.0022), and this was especially true for married (P = 0.0073) and less educated (P = 0.0014) patients at subgroup analysis. Stoma patients experienced greater financial worries (P = 0.0029), whereas nonstoma patients had greater gastrointestinal concerns (P = 0.0098).CONCLUSIONSAlthough most quality of life scores between stoma and nonstoma patients were similar, significant differences regarding body image, finance, and gastrointestinal symptoms, especially for married and less educated patients, were noticed. These factors should be taken into account, along with oncologic criteria, to better tailor treatments to patients.

To be or not to be empathic: the combined role of empathic concern and perspective taking in understanding burnout in general practice.

BackgroundGeneral practice is stressful and burnout is common among family physicians. A growing body of evidence suggests that the way physicians relate to their patients could be linked to burnout. The goal of this study was to examine how patterns of empathy explained physicians’ burnout.MethodsWe surveyed 294 French general practitioners (response rate 39%), measured burnout, empathic concern (EC) and perspective taking (PT) using self-reported questionnaires, and modeled burnout levels and frequencies with EC, PT and their interaction in linear and logistic regression analyses.ResultsMultivariate linear models for burnout prediction were associated with lower PT (β = −0.21, p < 0.001) and lower EC (β = −0.17, p < 0.05). Interestingly, the interaction (EC x PT) also predicted burnout levels (β = 0.11, p < 0.05). The investigation of interactions revealed that high scores on PT predicted lower levels of burnout independent from EC (odd ratios (OR) 0.37; 95% confidence interval (95% CI) 0.21–0.65 p < 0.001), and high scores on both EC and PT were protective against burnout: OR 0.31; 95% CI 0.15–0.63, p < 0.001).ConclusionsDeficits in PT alone might be a risk factor for burnout, whereas higher PT and EC might be protective. Educators should take into account how the various components of empathy are potentially associated with emotional outcomes in physicians.

Burnout and empathy in primary care: three hypotheses

In the last 10 years, a growing literature about empathy in primary care indicates that, for both patient and clinician, empathy helps to improve many aspects of health care practice and patient satisfaction. Wensing et al 1 indicated that humaneness, exploring the needs of patients, and good communication skills are some of the high priorities that patients expect from their GP. Cape et al 2 showed that doctor empathy coded by external observers was positively correlated with listening interactions and patient involvement. Vedsted and Heje3 found that patients tended to recommend their GP to others if they judged them as ‘empathic’. Mercer et al 4 showed a positive relationship both between GP empathy and patient enablement at the consultation, and between patient enablement and changes in the main symptom and well-being evaluated 3 months after the consultation. Finally, Verheul et al 5 investigated the impact of a warm and empathic consultation compared to a cold and formal consultation on the certainty of the outcome. The greatest beneficial effects of empathic communication on stress reduction and expectancies were observed when it was combined with a positive expectations style. To preserve effective empathy in care, the health provider must be in a positive frame of mind and not affected by stress or burnout. Burnout occurs when individuals feel emotionally overwhelmed by the …

Creativity as action: findings from five creative domains

The present paper outlines an action theory of creativity and substantiates this approach by investigating creative expression in five different domains. We propose an action framework for the analysis of creative acts built on the assumption that creativity is a relational, inter-subjective phenomenon. This framework, drawing extensively from the work of Dewey (1934) on art as experience, is used to derive a coding frame for the analysis of interview material. The article reports findings from the analysis of 60 interviews with recognized French creators in five creative domains: art, design, science, scriptwriting, and music. Results point to complex models of action and inter-action specific for each domain and also to interesting patterns of similarity and differences between domains. These findings highlight the fact that creative action takes place not “inside” individual creators but “in between” actors and their environment. Implications for the field of educational psychology are discussed.

Physicians’ understanding of patients’ personal representations of their diabetes: Accuracy and association with self-care

The degree of accuracy with which physicians understand their patients’ views may be of central importance for promoting self-care in the majority of chronic illnesses and in type 2 diabetes in particular. The objectives of this study were to measure the accuracy of the general practitioners’ understanding of the patients’ views and relate it to health behavioural outcomes in patients with non-complicated type 2 diabetes. The participants in this cross-sectional study consisted of 14 clinicians and 78 of their patients from Paris, France. The predictors were levels of accuracy in understanding the patients’ views derived from the illness perception questionnaire-revised (IPQ-R). The outcomes were patient-reported self-care measures. In regression models controlling for clinical and personal variables, higher accuracy on chronicity beliefs was associated with an improved diet and increased blood glucose self-testing and higher accuracy in identifying treatment control beliefs was associated with better dietary self-care. Accuracy was higher with regard to beliefs about causes, treatment control and consequences. These results suggest that accuracy may impact self-care in specific domains of illness perception but not others. The results may help identify useful avenues of communication training designed for professionals.

Empathic concern and professional characteristics associated with clinical empathy in French general practitioners

ABSTRACT Objective: Clinical empathy, i.e. the ability of physicians to adopt patient perspective, is an essential component of care, which depends in part on empathic concern, i.e. compassionate emotions felt for others. However, too much empathic concern can be challenging for physicians. Aim of this study was to examine physician practice characteristics that could explain clinical empathy beyond empathic concern. We were also interested in testing whether professional reflective activities, such as Balint group attendance or clinical supervision, might make clinical empathy less dependent on empathic concern. Methods: A total of 295 French general practitioners (response rate of 37%) completed self-reported questionnaires on empathic concern and clinical empathy, using the Toronto empathy questionnaire (TEQ) and the Jefferson scale of physician empathy (JSPE), respectively. We also recorded information on their professional practice: professional experience, duration of consultations, and participation in Balint groups or being a clinical supervisor. Hierarchical regression analyses were carried out with clinical empathy as dependent variable. Results: Empathic concern was an important component of clinical empathy variance. The physician practice characteristics ‘consultation length’ and ‘being a Balint attendee or a supervisor,’ but not ‘clinical experience’ made a significant and unique contribution to clinical empathy beyond that of empathic concern. Participating to one reflective activity (either Balint group attendance or clinical supervision) made clinical empathy less dependent on empathic concern. Conclusion: Working conditions such as having enough consultation time and having the opportunity to attend a professional reflective activity support the maintenance of clinical empathy without the burden of too much empathic concern.

A New Look at Creative Giftedness

In the target article, “Where does creativity fit into a productivist industrial model of knowledge production?”, Ghassib (2010) invites the reader to step back and consider some long term historical and socio-cultural trends concerning the field of science and its relationships to society. This perspective suggests that science has evolved to become an industry which is central to economic growth, engaging large sectors of the workforce. According to Ghass ib (2010), science has become the dominant mental paradigm of our times. Within this analysis, the concept of creativity plays an important role. Science is by its nature a creative endeavour. The result of a scientific process is new knowledge, new methods, and subsequently after application, new inventions, new products, and advances for society. Thus, the business of science is the creation of new knowledge, a creative endeavour just as much as artistic or literary work.

The long-term impact of hyperthermic intraperitoneal chemotherapy on survivors treated for peritoneal carcinomatosis: a cross-sectional study

BackgroundHyperthermic intraperitoneal chemotherapy (HIPEC) after complete surgical resection is currently accepted as a therapeutic option for peritoneal carcinomatosis. However, considerable morbidity is reported after HIPEC.ObjectiveWe aimed to evaluate the impact of HIPEC on the quality of life (QoL) of survivors without recurrences of disease according to socio-demographic and medical variables. For that purpose, HIPEC was used as a global concept including the surgical procedure effects.Materials and methodsA cross-sectional study was performed by analyzing questionnaires concerning socio-demographic data, the psychological status, and general and specific QoL scores.ResultsSixty-eight patients (86% of those contacted) completed and returned mailed questionnaires. For 19/21 QoL dimensions explored, survivors reported good to very good QoL with a median score ≥67%. The two adversely affected dimensions were future prospects and sexual functioning with a mean score of 57% and 23%, respectively. The burden of carcinomatosis, evaluated by a peritoneal index, was not correlated with statistically identified sequels in QoL. The extent of morbidity due to HIPEC, evaluated by the hospital stay, was statistically correlated with only one score, namely, embarrassment during social activities (p = 0.01) but not during familial life.ConclusionsEven though HIPEC is considered as an aggressive treatment, survivors reported good to very good QoL. However, specific care for the psychological aspect, as reflected by anxiety regarding future prospects and sexual activity, needs to be developed for survivors.

Burnout, empathy and their relationships: a qualitative study with residents in General Medicine

Some studies have shown that burnout may have a negative impact on clinical empathy during internship. However, clinical empathy may also be a protective factor, preventing residents from experiencing burnout. Although several quantitative studies have been conducted to examine these relationships between burnout and empathy, no qualitative studies have been carried out. To examine how residents in general practice evaluate the link between burnout and empathy, 24 of them participated in a semi-structured interview. A thematic analysis was carried out to examine residents’ discourses and answers to closed questions. The results indicated that residents thought that empathy and burnout were clearly related in different ways. They identified five types of relationship: regulation strategy, empathy as protection, psychological balance/imbalance, fatigue and moderating factors.

Social Representation of Gifted Children: A Preliminary Study in France

Abstract There is a growing recognition of giftedness in France and the need for identification. Social Representations (SR) of gifted children have never been examined in France with an appropriate methodology, yet it is important to do so as the information obtained may help ensure the insertion and inclusion of these children in school and society. The aim of the present preliminary study was to investigate the SR of gifted children in a French population using a free association methodology, a Vergès analysis (1992), and a similarity analysis (Flament, 1981). Both are recognized as valid and efficient tools for SR to be examined. The SR of gifted children by individuals who have had contact with such children is compared to the SR of gifted children by individuals with no contact. Results reveal that the SR by people familiar with gifted children include the concepts of intelligence, curiosity and sensitivity compared with the sole notion of intelligence as cited by the other group.