In mental health, as elsewhere, nurses are increasingly faced with clinical and organizational problems. At a time when the nursing profession is experiencing new perspectives through advanced practice, particularly in psychiatry and mental health, a cross-sectional view is proposed on the implementation of an experimentation of analysis groups of professional nursing practice at the Nancy psychotherapeutic center (54). The strengths, limits and perspectives of this system are presented for the teams, their management and for the clinical nurse specialist who leads the sessions.The burden of caregivers of patients with chronic diseases has been the subject of research for several years, but few studies have focused on the suffering of family members from the time of their first hospitalization in psychiatry. The identification of the determinants of this burden would allow us to propose early management aimed at improving the well-being of the patients' family and friends and maximizing intra-family resources.Working on the question of consent in psychiatry means studying closely the word given by a patient, who, before being mentally ill, is a person with a real human value. It is a question of eliciting consent, of seeking it tirelessly rather than demanding it, so that it never becomes a procedure imposed by the fact of setting a purely formal condition, at the risk of otherwise abandoning it to the power of the psychiatric doctor.  https://www.selleckchem.com/products/imd-0354.html  This is all the more important as the criterion of free care, including today both free hospitalization and freely deployed outpatient care, remains as an essential benchmark of the therapeutic alliance, the consent of the patient.It is not usual to use care without consent in the management of eating disorders when the patient refuses the care indicated. Yet, these are psychiatric disorders responsible for a high mortality rate and a high risk of chronicity. Their management is complex, multidisciplinary and the refusal of care in the most severe cases raises ethical questions. It is important for the clinician to know the impact of these disorders, notably on the patient's cognitive and judgment capacities, in order to evaluate the necessity of implementing a restraint measure.The part-time therapeutic reception center (CATTP) presented in this article has modified its organization in order to retain the adolescents who attend it. Clinical work on indications and the implementation of a reception protocol mobilized the team in view of admissions. The CATTP, in its current functioning, brings together the adolescent and his family, in search of a double consent.Consent must be sought by the doctor and caregivers on the basis of clinical insight. The argumentation must be coherent and well thought out, in order to facilitate the patient's choice. The question of consent is more important in psychiatry because of the different pathologies. The example of schizophrenia with the expression of delirium, hallucinations or disorganization reflects the difficulties encountered in the search for consent. This can then be apprehended as a therapeutic tool promoting meeting and trust.Consent and discernment are two important notions, constantly present in the daily life of psychiatric caregivers. The Haute Autorité de santé sheds valuable light on discernment by defining it in terms of five characteristics. As for consent, it is based on the fundamental principle of an agreement given on a proposal with a perception of the stakes by the different parties. The consequences within the multidisciplinary team are multiple, between the information recorded in the shared medical record, the care decisions according to the clinic and the impact on the patients' group. These are all serious ethical and practical difficulties.Medical paternalism has given way to the autonomy of the patient, who remains master of the decisions he makes concerning his health. His consent, free and informed, has no value unless it is preceded by information adapted to his degree of understanding. The notion of consent raises the question of freedom, and therefore of the autonomy left to patients in their choices. Individual freedom occupies a particular place in psychiatry where it comes into confrontation with constraint. The tensions generated must lead caregivers to ask themselves the right questions in accordance with the principles of medical ethics.
  Laparoscopic surgery has been widely used for rectal cancer; however, its long-term outcomes remain controversial. This study aimed to assess the long-term oncological safety of laparoscopic surgery for rectal cancer using 10-year follow-up data of the Comparison of Open versus laparoscopic surgery for mid or low REctal cancer After Neoadjuvant chemoradiotherapy (COREAN) trial.
 
  The COREAN trial is a, open-label, non-inferiority, randomised controlled trial. Eligible participants were aged 18-80 years, had cT3N0-2M0 middle or low rectal cancer with lesions located within 9 cm of the anal verge, and had been treated with preoperative chemoradiotherapy. Patients were randomly assigned (11) to open or laparoscopic surgery with a computer-generated random allocation sequence with a random permuted block design. Neither patients nor clinicians were masked to treatment assignment. Open or laparoscopic total mesorectal excision was done 6-8 weeks after the administration of preoperative concurrent chemoradiotherap=0·44), 10-year disease-free survival (59·3% [51·1-66·5] vs 64·3% [56·0-71·5]; p=0·20), or 10-year local recurrence (8·9% [5·2-15·0] vs 3·4% [1·4-7·9]; p=0·050) between the open surgery and laparoscopic surgery groups at 10 years after surgery. The stratified hazard ratios, adjusted for ypT and ypN classification and tumour regression grade, for open surgery versus laparoscopic surgery were 0·94 (95% CI 0·63-1·43) for overall survival, 1·05 (0·74-1·49) for disease-free survival, and 2·22 (0·78-6·34) for local recurrence.
 
  The 10-year follow-up of the COREAN trial confirms the long-term oncological safety of laparoscopic surgery in patients with rectal cancer treated with preoperative chemoradiotherapy. Similar to open surgery, laparoscopic surgery does not compromise long-term survival outcomes in rectal cancer when performed by well trained surgeons.
 
  National Cancer Center, Goyang, South Korea.
 National Cancer Center, Goyang, South Korea.