Place de l'oxygénothérapie hyperbare dans le traitement des gelures : évaluations des pratiques européennes

Role of hyperbaric oxygen therapy in the treatment of frostbite: evaluation of common practices in Europe. Frostbite is a medical condition where the efficacy of hyperbaric oxygen therapy (HBOT) remains controversial and has not yet been proved scientifically. Frostbite is a tissue damage that occurs during prolonged and direct exposure to a temperature below 0°C. HBO is worth consideration as an adjunct therapy in frostbite management as it improves local oxygenation, reduces oedema, increases bactericidal activity and stimulates the healing process. Our study has been motivated by good clinical results in treatment of frostbites reported by the team of Hyperbaric Center in the Hospital of Sainte-Marguerite in Marseille. The main goal of this work was to describe the common practices while frostbite treatment in hyperbaric centers in Europe. Secondary endpoints were to verify if there was a therapeutic benefit of HBO in frostbite patients. Our questionnaire was sent to 134 hyperbaric chambers in Europe. 21 physicians completed the questionnaire. 86% of these specialists agreed that HBO could theoretically be indicated in frostbite treatment. Among the 25 patients included in the study, 84% were suffering from severe frostbites and only 44% received HBO in the first 72 hours. Despite these facts, during the first 3 months of evolution, 88% of patients showed improvement of skin lesions. Although the results did not meet statistical significance, these data suggest that using HBO as an adjunct therapy may be beneficial for patients suffering from frostbites, even at a late stage. Therefore, large prospective studies are necessary and justified.À l'heure actuelle, l'oxygénothérapie hyperbare (OHB) ne fait pas partie des recommandations pour le traitement des gelures et pourtant elle est proposée par plusieurs spécialistes. La gelure est une lésion tissulaire survenant lors d'une exposition prolongée et directe à une température inférieure à 0°C. L'OHB pourrait être utile par le biais de l'amélioration de l'oxygénation locale, la limitation de l'œdème, la lutte contre l'infection et la stimulation des processus de cicatrisation. L'équipe du centre hyperbare de l'Hôpital de Sainte-Marguerite à Marseille avait traité les victimes de gelures avec des résultats très encourageants, ce qui nous a motivé à évaluer les pratiques concernant l'utilisation de l'OHB dans la prise en charge des gelures dans différents centres hyperbares Européens et vérifier, s'il avait existé un bénéfice thérapeutique. Il s'agit d'une étude réalisée à l'aide d'un questionnaire auprès des médecins exerçant aux caissons hyperbares en Europe. Sur 134 messages envoyés, 21 médecins avaient rempli le questionnaire. 86% des spécialistes estimaient que théoriquement l'OHB pourrait être indiquée dans la prise en charge de gelures. Parmi les 25 patients inclus, 84% avaient été atteints de gelures profondes et seulement 44% avaient bénéficié d'une prise en charge dans les premières 72 heures. Malgré la gravité des lésions et le délai de la prise en charge, nous avons constaté, qu'à 3 mois d'évolution, 88% des patients avaient présenté une amélioration sur le plan cutané par rapport à l'état initial. Bien que notre étude ne soit pas d'une grande valeur statistique, elle permet toutefois de s'apercevoir du bénéfice thérapeutique que l'OHB pourrait apporter dans cette pathologie, y compris tardivement. En effet, des études prospectives larges seront nécessaires et justifiées

Place de l'oxygénothérapie hyperbare dans le traitement des gelures : évaluations des pratiques européennes

Role of hyperbaric oxygen therapy in the treatment of frostbite: evaluation of common practices in Europe. Frostbite is a medical condition where the efficacy of hyperbaric oxygen therapy (HBOT) remains controversial and has not yet been proved scientifically. Frostbite is a tissue damage that occurs during prolonged and direct exposure to a temperature below 0°C. HBO is worth consideration as an adjunct therapy in frostbite management as it improves local oxygenation, reduces oedema, increases bactericidal activity and stimulates the healing process. Our study has been motivated by good clinical results in treatment of frostbites reported by the team of Hyperbaric Center in the Hospital of Sainte-Marguerite in Marseille. The main goal of this work was to describe the common practices while frostbite treatment in hyperbaric centers in Europe. Secondary endpoints were to verify if there was a therapeutic benefit of HBO in frostbite patients. Our questionnaire was sent to 134 hyperbaric chambers in Europe. 21 physicians completed the questionnaire. 86% of these specialists agreed that HBO could theoretically be indicated in frostbite treatment. Among the 25 patients included in the study, 84% were suffering from severe frostbites and only 44% received HBO in the first 72 hours. Despite these facts, during the first 3 months of evolution, 88% of patients showed improvement of skin lesions. Although the results did not meet statistical significance, these data suggest that using HBO as an adjunct therapy may be beneficial for patients suffering from frostbites, even at a late stage. Therefore, large prospective studies are necessary and justified.À l'heure actuelle, l'oxygénothérapie hyperbare (OHB) ne fait pas partie des recommandations pour le traitement des gelures et pourtant elle est proposée par plusieurs spécialistes. La gelure est une lésion tissulaire survenant lors d'une exposition prolongée et directe à une température inférieure à 0°C. L'OHB pourrait être utile par le biais de l'amélioration de l'oxygénation locale, la limitation de l'œdème, la lutte contre l'infection et la stimulation des processus de cicatrisation. L'équipe du centre hyperbare de l'Hôpital de Sainte-Marguerite à Marseille avait traité les victimes de gelures avec des résultats très encourageants, ce qui nous a motivé à évaluer les pratiques concernant l'utilisation de l'OHB dans la prise en charge des gelures dans différents centres hyperbares Européens et vérifier, s'il avait existé un bénéfice thérapeutique. Il s'agit d'une étude réalisée à l'aide d'un questionnaire auprès des médecins exerçant aux caissons hyperbares en Europe. Sur 134 messages envoyés, 21 médecins avaient rempli le questionnaire. 86% des spécialistes estimaient que théoriquement l'OHB pourrait être indiquée dans la prise en charge de gelures. Parmi les 25 patients inclus, 84% avaient été atteints de gelures profondes et seulement 44% avaient bénéficié d'une prise en charge dans les premières 72 heures. Malgré la gravité des lésions et le délai de la prise en charge, nous avons constaté, qu'à 3 mois d'évolution, 88% des patients avaient présenté une amélioration sur le plan cutané par rapport à l'état initial. Bien que notre étude ne soit pas d'une grande valeur statistique, elle permet toutefois de s'apercevoir du bénéfice thérapeutique que l'OHB pourrait apporter dans cette pathologie, y compris tardivement. En effet, des études prospectives larges seront nécessaires et justifiées

Video-based feedback as a method for training rural healthcare workers to manage medical emergencies: a pilot study

Abstract Background Video-based feedback has been shown to aid knowledge retention, skills learning and improve team functionality. We explored the use of video-based feedback and low fidelity simulation for training rural healthcare workers along the Thailand-Myanmar border and Papua New Guinea (PNG) to manage medical emergencies effectively. Methods Twenty-four study participants were recruited from three Shoklo Malaria Research Unit clinics along the Thailand-Myanmar border and eight participants from Kudjip Nazarene Hospital, PNG. The teams were recorded on video managing a simulated medical emergency scenario and the video was used to aid feedback and assess performance using Observed Structured Clinical Examination (OSCE) scoring and Team Emergency Assessment Measure (TEAM) questionnaire. The process was repeated post-feedback at both sites and at 6 weeks at the Thailand-Myanmar border site. Thailand-Myanmar border participants’ individual confidence levels and baseline knowledge (using OSCE scoring) were assessed before team assessment and feedback at week 1 and repeated post-feedback and at 6 weeks. Focus group discussions (FGD) were held at each Thailand-Myanmar border clinic at week 1 (8 participants at each clinic). Results Individual paired tests of OSCE scores showed significant improvement post-feedback at week 1 (p < 0.001) and week 6 (p < 0.001) compared to baseline OSCE scores. There was a trend for increased team OSCE scores compared to baseline at week 1 (p = 0.068) and week 6 (p = 0.109) although not significant. Thailand-Myanmar border TEAM scores demonstrated improvement post-feedback mainly in leadership, teamwork and task management which was sustained up to week 6. PNG showed an improvement mainly in teamwork and task management. The global rating of the teams’ non-technical performance at both sites improved post feedback and at week 6 on the Thailand-Myanmar border site. Self-rated confidence scores by Thailand-Myanmar border participants increased significantly from baseline following training at week 1 (p = 0.020), and while higher at 6 weeks follow up than at baseline, this was not significant (p = 0.471). The FGD revealed majority of participants felt that watching the video recording of their performance and the video-based feedback contributed most to their learning. Conclusion Video-assisted feedback resulted in an improvement in clinical knowledge, confidence and quality of teamwork for managing medical emergencies in two low resource medical facilities in South East Asia and the South Pacific

Additional file 1: of Video-based feedback as a method for training rural healthcare workers to manage medical emergencies: a pilot study

OSCE scoring form for assessing ABCDE approach to medical emergencies management. (DOCX 14 kb