Suchergebnisse

Au moment même où notre société semble prendre la mesure de la réalité de son vieillissement et où notre système de santé interroge sa propre adéquation à cette réalité, il apparaît essentiel de porter un regard sur la mort et sur la vieillesse qui y conduit afin de penser les enjeux majeurs pour notre société et pour notre système de santé futur. Cet article interroge ainsi les nouvelles formes de fin de vie concernant les personnes âgées, il montre le rapport ambigu que notre société entretient tant avec le vieillissement qu'avec la mort, le paradoxe entre les discours et les faits, entre le vieillissement effectif et l'insuffisance de son accompagnement dans notre société moderne. Il rappelle les mesures existantes ou en cours pour l'accompagnement du vieillissement et de la fin de la vie et envisage au final les pistes possibles pour une évolution vers une société inclusive à l'égard des personnes âgées les plus vulnérables, à la fin de leur existence.

International audience ; To fit the globalized economical environment, more and more SMEs have to develop networked and collaborative strategies. Such collaborative networks are mostly based on trusted and well known networks. At the international level, the European Union promotes clearly internet of services based solutions to support innovative business communities of organisations. The results accumulated by various projects provide a consistent environment (including methods, design tools and ESB-based developments) to support, at a technological level, Business Service oriented organizations. Nevertheless, these visions are mostly technology oriented and lack of taking into account industrial characteristics. To overcome this limit, we aim at integrating industrial functional and non functional business and industrial properties (including management strategy, quality, process maturity.) in service registries. This improves service selection and composition to set consistent dynamic collaborative organizations based on trusted business communities of organisations.

International audience ; To fit the globalized economical environment, more and more SMEs have to develop networked and collaborative strategies. Such collaborative networks are mostly based on trusted and well known networks. At the international level, the European Union promotes clearly internet of services based solutions to support innovative business communities of organisations. The results accumulated by various projects provide a consistent environment (including methods, design tools and ESB-based developments) to support, at a technological level, Business Service oriented organizations. Nevertheless, these visions are mostly technology oriented and lack of taking into account industrial characteristics. To overcome this limit, we aim at integrating industrial functional and non functional business and industrial properties (including management strategy, quality, process maturity.) in service registries. This improves service selection and composition to set consistent dynamic collaborative organizations based on trusted business communities of organisations.

International audience ; To fit the globalized economical environment, more and more SMEs have to develop networked and collaborative strategies. Such collaborative networks are mostly based on trusted and well known networks. At the international level, the European Union promotes clearly internet of services based solutions to support innovative business communities of organisations. The results accumulated by various projects provide a consistent environment (including methods, design tools and ESB-based developments) to support, at a technological level, Business Service oriented organizations. Nevertheless, these visions are mostly technology oriented and lack of taking into account industrial characteristics. To overcome this limit, we aim at integrating industrial functional and non functional business and industrial properties (including management strategy, quality, process maturity.) in service registries. This improves service selection and composition to set consistent dynamic collaborative organizations based on trusted business communities of organisations.

International audience ; To fit the globalized economical environment, more and more SMEs have to develop networked and collaborative strategies. Such collaborative networks are mostly based on trusted and well known networks. At the international level, the European Union promotes clearly internet of services based solutions to support innovative business communities of organisations. The results accumulated by various projects provide a consistent environment (including methods, design tools and ESB-based developments) to support, at a technological level, Business Service oriented organizations. Nevertheless, these visions are mostly technology oriented and lack of taking into account industrial characteristics. To overcome this limit, we aim at integrating industrial functional and non functional business and industrial properties (including management strategy, quality, process maturity.) in service registries. This improves service selection and composition to set consistent dynamic collaborative organizations based on trusted business communities of organisations.

International audience ; The globalised and moving economical environment leads enterprises to develop networked strategies. Such collaborative networks are by now often based on trusted and well known communities and require IT support agility and interoperability. The European Union promotes solutions to support and favor innovative business networks on the basis of an internet of services: these FP6 and FP7 projects results provide a consistent environment (including design, methods and developments related to Enterprise Service Bus (ESB) technology) to support technologically Business Service oriented organizations and the large-scale reinforcement of collaborative business and networked organization strategies. Nevertheless these works are mostly focused on an IT vision without taking into account business constraints. To overcome this limit, we propose a multi-dimensional service-chain ecosystem model, paying attention on service functional and non-functional properties description to support an efficient and consistent business service selection and composition process so that large-scale service based collaborative organization can emerge.

International audience ; The globalised and moving economical environment leads enterprises to develop networked strategies. Such collaborative networks are by now often based on trusted and well known communities and require IT support agility and interoperability. The European Union promotes solutions to support and favor innovative business networks on the basis of an internet of services: these FP6 and FP7 projects results provide a consistent environment (including design, methods and developments related to Enterprise Service Bus (ESB) technology) to support technologically Business Service oriented organizations and the large-scale reinforcement of collaborative business and networked organization strategies. Nevertheless these works are mostly focused on an IT vision without taking into account business constraints. To overcome this limit, we propose a multi-dimensional service-chain ecosystem model, paying attention on service functional and non-functional properties description to support an efficient and consistent business service selection and composition process so that large-scale service based collaborative organization can emerge.

International audience ; The globalised and moving economical environment leads enterprises to develop networked strategies. Such collaborative networks are by now often based on trusted and well known communities and require IT support agility and interoperability. The European Union promotes solutions to support and favor innovative business networks on the basis of an internet of services: these FP6 and FP7 projects results provide a consistent environment (including design, methods and developments related to Enterprise Service Bus (ESB) technology) to support technologically Business Service oriented organizations and the large-scale reinforcement of collaborative business and networked organization strategies. Nevertheless these works are mostly focused on an IT vision without taking into account business constraints. To overcome this limit, we propose a multi-dimensional service-chain ecosystem model, paying attention on service functional and non-functional properties description to support an efficient and consistent business service selection and composition process so that large-scale service based collaborative organization can emerge.

International audience ; The globalised and moving economical environment leads enterprises to develop networked strategies. Such collaborative networks are by now often based on trusted and well known communities and require IT support agility and interoperability. The European Union promotes solutions to support and favor innovative business networks on the basis of an internet of services: these FP6 and FP7 projects results provide a consistent environment (including design, methods and developments related to Enterprise Service Bus (ESB) technology) to support technologically Business Service oriented organizations and the large-scale reinforcement of collaborative business and networked organization strategies. Nevertheless these works are mostly focused on an IT vision without taking into account business constraints. To overcome this limit, we propose a multi-dimensional service-chain ecosystem model, paying attention on service functional and non-functional properties description to support an efficient and consistent business service selection and composition process so that large-scale service based collaborative organization can emerge.

En France, près de la moitié des décès (48 % en 2010) a été précédée d'une décision médicale ayant pu hâter la mort du patient. Mais des médicaments ont été donnés pour mettre délibérément fin à la vie dans seulement moins de 1 % des cas. Les décisions prises s'appuient dans leur grande majorité sur les dispositions de la loi Leonetti qui permet sous certaines conditions de limiter ou d'arrêter un traitement, ou d'administrer des médicaments afin de soulager les souffrances du patient, qui peuvent avoir pour effet d'avancer la survenue de la mort. Toutefois, les prescriptions légales encadrant ces décisions ne sont pas encore totalement connues ou respectées : les décisions de fin de vie ne sont pas toujours discutées avec les patients et les équipes soignantes ; la rédaction par les patients de directives anticipées, proposée par la loi Leonetti pour que les soignants prennent en compte leurs souhaits, reste en pratique très rare.

Abstract Background The "Patients' Rights and End of Life Care" Act came into force in France in 2005. It allows withholding/withdrawal of life-support treatment, and intensified use of medications that may hasten death through a double effect, as long as hastening death is not the purpose of the decision. It also specifies the requirements of the decision-making process. This study assesses the situation by examining the frequency of end-of-life decisions by patients' and physicians' characteristics, and describes the decision-making processes. Methods We conducted a nationwide retrospective study of a random sample of adult patients who died in December 2009. Questionnaires were mailed to the physicians who certified/attended these deaths. Cases were weighted to adjust for response rate bias. Bivariate analyses and logistic regressions were performed for each decision. Results Of all deaths, 16.9% were sudden deaths with no information about end of life, 12.2% followed a decision to do everything possible to prolong life, and 47.7% followed at least one medical decision that may certainly or probably hasten death: withholding (14.6%) or withdrawal (4.2%) of treatments, intensified use of opioids and/or benzodiazepines (28.1%), use of medications to deliberately hasten death (i.e. not legally authorized) (0.8%), at the patient's request (0.2%) or not (0.6%). All other variables held constant, cause of death, patient's age, doctor's age and specialty, and place of death, influenced the frequencies of decisions. When a decision was made, 20% of the persons concerned were considered to be competent. The decision was discussed with the patient if competent in 40% (everything done) to 86% (intensification of alleviation of symptoms) of cases. Legal requirements regarding decision-making for incompetent patients were frequently not complied with. Conclusions This study shows that end-of-life medical decisions are common in France. Most are in compliance with the 2005 law (similar to some other European countries). Nonetheless, the study revealed cases where not all legal obligations were met or where the decision was totally illegal. There is still a lot to be done through medical education and population awareness-raising to ensure that the decision-making process is compatible with current legislation, the physician's duty of care and the patient's rights.

En France, dans les décennies à venir, avec l'arrivée des générations du baby-boom au grand âge et l'augmentation de l'espérance de vie, le nombre de décès, notamment de personnes très âgées, va augmenter. Dans une proportion importante, ces décès seront précédés de maladies chroniques longues et potentiellement invalidantes requérant soins et aides. Actuellement, près de la moitié des décès (48 % en 2010) a été précédée d'une décision médicale ayant pu hâter la mort du patient. Les décisions prises s'appuient dans leur grande majorité sur les dispositions de la loi Leonetti, qui permet, sous certaines conditions, de limiter ou d'arrêter un traitement, ou d'administrer des médicaments pour soulager les souffrances du patient, qui peuvent avoir pour effet d'avancer la survenue de la mort.

La majorité des personnes souhaitent mourir chez elles, mais un quart seulement le font. L'enquête « Fin de vie en France » permet de retracer le parcours résidentiel et médical avant le décès. Quatre semaines avant leur mort, 45 % des personnes vivent à domicile en cas de décès non soudain. Quitter son domicile pour entrer à l'hôpital et y décéder est le parcours le plus fréquent (30 %), passer l'ensemble du dernier mois de l'existence chez soi l'est deux fois moins (14 %). Le départ de l'hôpital pour regagner son domicile est beaucoup plus rare (2 %). La complexité des soins rend souvent le maintien à domicile impossible, ce qui motive le transfert à l'hôpital. C'est de fait la raison la plus souvent évoquée pour justifier le non-respect du souhait de certains patients de décéder chez eux.

Cet article décrit les lieux de vie et trajectoires résidentielles des personnes durant le dernier mois de leur existence, à partir de l'enquête Fin de vie en France réalisée en 2010. L'enquête repose sur un échantillon représentatif des décès survenus en décembre 2009. Les médecins ayant certifié les décès ont été interrogés sur les circonstances de la fin de vie. Si 3 personnes sur 5 meurent à l'hôpital, seules la moitié étaient hospitalisées un mois avant leur décès. Dans ce laps de temps, l'hospitalisation à partir du domicile est le changement le plus fréquemment observé. Les personnes prises en charge en maison de retraite ou à l'hôpital un mois avant leur décès ont une forte probabilité d'y finir leurs jours. Des analyses multivariées montrent que l'âge et le sexe influencent le parcours de fin de vie : ce sont les plus âgés et les femmes qui présentent le plus fort risque de vivre leur dernier mois en maison de retraite. Les symptômes, le type de maladies et la finalité des traitements conditionnent les lieux de la fin de vie des patients. Toutes les situations cliniques ne permettent pas de maintenir les personnes à domicile : le traitement d'épisodes aigus, les détresses respiratoires ou les problèmes digestifs sont plus souvent traités à l'hôpital, les troubles mentaux en maison de retraite et les difficultés de déplacement dans chacun de ces lieux.