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Speaking on behalf of others is no easy task. When 30 members of a psychiatric hospital's ethics committee rely on three of them to explain its functions and roles to neophytes, and to put into words what the committee represents in their eyes, the mission is a delicate one. We have to remain as faithful to our own thinking as we are to the spirit of the group. We will try to answer these questions as best we can, to shed light on the origins, missions and specific features of an ethics committee in a psychiatric hospital, without betraying our own thinking or that of our colleagues., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Morality, ethics, ethical approach are words that are often used in our daily lives as health care providers. What meaning do they have? How important are they? If ethics is an individual notion, the question arises of its application in our accompaniment., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: The development of robot-assisted urological surgery is held back by the lack of robust medico-economic analyses and their heterogeneity. We conducted a medico-economic study to evaluate the implementation of measures to optimize the transition to robotic surgery., Method: We carried out a single-center, controlled study from the point of view of the public healthcare establishment for 4 years. Economic data collection was based on a micro-costing method and revenues from stay-related groups. Clinical data corresponded to mean lengths of stay, operating duration, complications and stays in intensive care. The measures to optimize the transition to robotic, implemented mid-study period, enabled before/after comparison., Results: Altogether, 668 patients undergoing robotic surgery were included. Robotic activity increased significantly from periods 1 to 2 to 256% (P=<0.001) as did the overall proportion of robotic by 45% to 85% (P=<0.001). The mean lengths of stay fell significantly, 6.8 d vs. 5.1 d (P<0.001). Costs and revenues increased significantly, resulting in a persistent deficit for the activity €226K vs. €382K (P=<0.001). With increased volume of activity, the deficit per operation and the cost per minute of robotic operating room fell significantly, €3,284 vs. €1,474/procedure (P=<0.001) and €27 vs €24/min (P=<0.029), tending towards a break-even point (=zero deficit) at 430 operations per year., Conclusions: Robotic-assisted surgery can be significantly optimized by implementing measures for the robotic turn to reach a break-even point at 430 operations per year. A better multidisciplinary case mix could lower the break-even volume of activity in short term., Level of Evidence: 3., (Copyright © 2021 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Purpose: Pressure to eliminate low-value health care is increasing internationally. This pressure has produced an urgent need to identify evidence-based methods to determine the value of allied health (AH) care, particularly to recognize when additional AH care adds no further benefits. This article reports on the published methods of determining the value of AH care. Method: We systematically scanned PubMed, MEDLINE, AMED, CINAHL, PsycINFO, and the Grey Literature Review database from inception until July 2018 for peer-reviewed English-language literature. Hierarchy of evidence and information on study design and the methods or measures used to determine the value of AH care were extracted. Results: Of 189 articles, 30 were potentially relevant; after the full text was read, all were included. Of these, 24 reported on ways of determining the value of AH care, and 6 described the optimal provision of AH episodes of care. No methods were reported that could be applied to establish when enough AH therapy had been provided. Conclusion: This review found a variety of attributes of value in AH care, but no standard value measure or methods to determine what constituted enough AH care. Repeated measurement of the standard attributes of value and costs is required throughout episodes of AH care to better understand the impact of AH care from the different stakeholders' perspectives., (© Canadian Physiotherapy Association.)

Following the outbreak of coronavirus disease, many experience feedbacks have been set up, at the level of departments, hospitals or crisis units. In a geriatric ward, this helped to understand what had happened to each of the caregiver and to the community. In the event of a new wave, this will allow them to anticipate. This period strengthened the sense of belonging and the interest in the well-being of the care receiver., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Talking about care refers us directly to the values which shape it. At a time when these values are under threat, it is the very idea of caring which is in danger. Its moral and ethical foundations must be reasserted., (Copyright © 2018. Published by Elsevier Masson SAS.)

It appears that, to survive, all people need a commitment, whatever their motivations, their degree of involvement and the time they can dedicate to it. What does "commitment" really mean to nursing students?, (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Why would anyone want to become a firefighter nurse? This obviously twofold commitment is usually the result of an individual and family history, although other factors are also at work. The need to serve is reinforced by the professional's social audience, the particular features of emergencies, the independence, the hierarchy and the positive emotions associated with this profession., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Volunteering to serve the general interest, that is the profession of faith behind associative commitments. Notably, actions by associations undertaken in favour of organ donation today must, in their content and forms, reconcile tradition and modernity. But they keep their driving principles and values intact., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Ethics is on the cross road of off values that are present along the ways of transfusion medicine. This is an important tool to afford opinions as well as debates that always emerge when discussing transfusion medicine. The wording is particularly important; this was one among several others that characterized the soul of Jean-Jacques Lefrère when he opened the doors of the ethical issues of transfusion medicine., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

The evolution of science and our society raises ethical questions in medical and nursing practice. These give rise to the requirement for individual and collective reflection in order to consider the consequences of decisions and to judge on sometimes complex choices. This reflection concerns both nursing practices and the organisation of the health system., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

For the first time, and as an exceptional option, the 2012 LEEM-CEPS framework agreement introduces the notion of conditional prices in conventional practice. The contractualization of drug price according to changes in its value that could occur in "real world" enables the Payer and the Company to settle, in a predictable manner, the "bet" represented by first registration price setting. Its systematization is based on the ability to standardize the implementation and assessment of observational studies, whereas the analysis and sharing of the risk of value changes (depreciation, appreciation) are structuring elements of the contractualization. Ethical from both the payer's and patient's point of view, drug price conditionality on its value is impeded by compliance with legal and economic constraints for the company, that should be taken into account by legalising this latter's ability to influence it through observance or therapeutic education and by guaranteeing a sufficiently long period of revenues for the company., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

In order to alleviate the inherent uncertainty that comes with the market access and public funding of new health products, a conditional reimbursement mechanism is proposed. The latter is circumscribed by recommendations regarding its implementation in limited cases in order to allow for a fair access of patients to therapeutic innovations, within economic conditions both optimum and reviewable., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Across global borders and throughout the various sectors of health care, the search for viable methods to pay for value has intensified. Driven by soaring costs and constrained budgets, public and private payers are seeking innovative ways to incentivize providers and product manufacturers to focus on effective outcomes for patients according to key performance indexes. Conditional pricing and performance-based payment for innovative medicines could facilitate access to quasi-monopsonic french market, in a context of financial crisis, loss of reciprocal confidence, and growing aversion for therapeutic and economical uncertainty. However, we consider these new methods of payment should not be termed "risk-sharing agreements", a misleading term despite its common use today. They also should not impact the national list prices of medicines, that is a decisive tool for stabilizing international trade., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Market Access Agreements (MAA) for drugs have emerged in response to the need to control health expenditures, as well as to the uncertainty about the true benefit of a drug. It is possible to group MAA in two types of agreements: financial agreements and outcome-based agreements. MAA is a growing trend and is shifting towards conditional access. However, the willingness to use these contracts and their implementation differ across countries, and some are still resistant to put them in place. The MAA challenges to overcome encompass the complexity of the schemes, the administrative burden and the difficulty of evaluating MAA. It is likely that these agreements might experience further evolution in the future to become a faster pathway for therapeutic innovations, at a fair price., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

In recent decades, the pharmaceutical industry as built a high level of confidence thanks to innovative medicines that improve both duration and quality of life. Some recent scandals have however discredited this industry, now suspected of cheating or bribery. Even the scientific progresses are challenged on the ground of possible conflicts of interests and value uncertainty. This situation is deleterious. Simultaneously the economic crisis exacerbates the payers' expectations in terms of clinical value and value/price ratio. It also stimulates the demand for outcomes in real life. This induces a new economic approach for the market access of highly expensive reimbursable drugs. It consists in paying only for drugs actually proven effective in terms of actual outcomes, with a full or partial refund of the payer in case of failure, according to accurate and simple criteria in so called "performance agreement". Confidence is restored accordingly., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)