Les concepts de continuité et de globalité des soins sont reconnus aujourd’hui par tous comme inhérents à la médecine moderne. Un groupe de travail s’est réuni pour proposer des modèles de coordination des soins de support pour toutes les maladies graves dans les différents établissements de soins privés et publics. Les « soins de support » sont : « l’ensemble des soins et soutiens nécessaire aux personnes malades, parallèlement aux traitements spécifiques, lorsqu’il y en a, tout au long des maladies graves ». Cette définition est inspirée de la définition du « supportive care » donnée en 1990 par la MASCC - Multinational Association for Supportive Care in Cancer : « The total medical, nursing and psychosocial help which the patients need besides the specific treatment ». Elle intègre autant le champ de la guérison avec éventuelles séquelles que celui des soins palliatifs dont la définition est précisée (phases palliatives initiale et terminale).Une telle coordination est justifiée par la pluridisciplinarité liée à l’hyperspécialisation et à l’hypertechnicité des professionnels, par une insuffisance de communication entre les équipes, par les difficultés administratives des équipes participant aux soins de support. Le groupe de travail insiste sur le fait que les soins de support ne sont pas une nouvelle spécialité. Il propose la création de fédérations, départements ou pôles de responsabilité de soins de support avec une « coordination de base » impliquant les activités de prise en charge de la douleur chronique rebelle, de soins palliatifs, de prise en charge psychologique, et d’accompagnement social. Cette coordination peut s’étendre, en fonction de « l’histoire » et des missions des établissements. Le service rendu par la mise en place « d’un guichet unique » pour les malades et les équipes est un point important. La structure doit répondre à certains cahiers des charges (Consultation, Unité ou Centre de lutte contre la douleur chronique rebelle, structures de soins palliatifs, de psycho-oncologie, de nutrition, d’accompagnement social…). Une mise en commun du plateau technique est un des intérêts. La structure doit mettre en place des liens forts avec les professionnels libéraux, les réseaux, l’hospitalisation à domicile (HAD) et les services de soins infirmiers à domicile (SSIAD), quand ils existent, pour garantir la continuité des soins de support sous tous ses aspects et pour que les préférences des malades puissent être prises en compte. Selon les propositions Hôpital 2007, le Groupement de Coopération Sanitaire (GCS) élargi, souple et polyvalent, répond parfaitement aux besoins inhérents aux structures de soins de support au sein des territoires de santé, puisqu’il peut être constitué entre un ou plusieurs établissements de santé et des professionnels libéraux de santé, favorisant ainsi la coopération entre établissements publics de santé, établissements privés, PSPH et médecine de ville.The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for coordination of supportive care for all severe illnesses in various private and public healthcare centres. Supportive care was defined as “all care and supports necessary for ill people, at the same time as specific treatments, during all severe illnesses”. This definition was inspired by the definition of “supportive care” given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): “the total medical, nursing and psycho-social help the patients need besides the specific treatment.” This definition integrates both the field of curative care with all possible after-effects and palliative care, which is clarified (initial and terminal palliative phases). This type of coordination is warranted because of the pluridisciplinary nature of healthcare and hyperspecialization of the professionals as well as because of poor communication between teams and administrative obstacles encountered by teams participating in supportive care. The working group emphasized the fact that supportive care is not a new specialty. The group proposed creating units, departments, or poles of responsibility of supportive care with a “basic coordination” involving the activities of chronic pain, palliative care, psycho-oncology, and social care. This coordination can be extended, depending on the history of each centre's healthcare missions. Service provided within the framework of a “unique care unit” for patients and healthcare givers is an important point. The structure must comply with the terms and conditions of the healthcare contract (consultation, chronic pain unit or center, structures for palliative care, psycho-oncology, nutrition, social care). A common technical organization is one of the interesting aspects. The structure must establish strong links with private practitioners, and existing networks, home care teams, and home nursing services to guarantee continuous and global supportive care taking into account the patient's desires. According to the Hospital 2007 propositions, the extended, flexible, general purpose Group of Sanitary Cooperation (GCS) meets perfectly the prerequisites inherent to supportive care structures within the areas of healthcare because its can be established between one or several healthcare centers and private health professionals, thus favoring cooperation between public and private healthcare centers, the public hospital system, and general medicine.

Electron detection in EXAFS is commonly used at room temperature for thick samples (where transmission measurements are not possible) or nanostructures with high element concentrations (where fluorescence detection is not appropriate). Recently, a Total Electron Yield detector with He gas flow at atmospheric pressure working at liquid nitrogen temperature has been developed and successfully tested on the French CRG/IF beamline at ESRF. At 80 K, the substantial decrease of the dynamic part of the Debye-Waller (DW) factor enables to record EXAFS signals on a larger k range and hence to obtain better signal-to-noise ratio of the corresponding Fourier Transform. A variation of the temperature of the sample from 80 to 300 K can be performed to evaluate the vibrational and the structural part of the DW factors. Moreover, in order to get rid of Bragg peaks in the EXAFS signal in case of monocrystalline samples, a special 360° rotating sample holder has been designed. Finally, polarization studies for anisotropic systems may be realized by simply rotating the sample holder by 90° from the in-plane to the out-of-plane polarization sample geometry.

This paper describes the first experimental determination of the migration temperature of freely diffusing self-interstitials in magnesium. This observation was made possible by analysis of the elastic modulus and damping variations induced by the pinning of the dislocations by self-interstitials. A marked pinning stage is found between 9 K and 14 K, which is definite evidence for the long-range diffusion of the self-interstitial at these temperatures. Prior data are discussed and reinterpreted in the light of this finding.

Internal friction and modulus measurements have been performed on high-purity cold-worked magnesium which was bombarded by electrons at low temperature during successive anneals up to 250K. The variation of Bordoni-type peaks is discussed in terms of pinning and diffusion of defects along dislocations lying along the Peierls' valleys. Some very low-temperature peaks are associated with an interaction between radiation-induced defects and geometrical kinks.