Synthèse des données disponibles sur la tolérance digestive suite à une réalimentation orale dans le contexte d'une chirurgie digestive: travail de Bachelor

Introduction : Les professionnels de la santé et les auteurs d’articles scientifiques citent et utilisent fréquemment le concept de la tolérance digestive. Il n’existe à ce jour aucun consensus sur la définition de « tolérance digestive ». Les variables utilisées pour la mesurer et la caractériser ainsi que sa prise en charge sont hétérogènes au niveau national et international. Plusieurs facteurs peuvent influencer la tolérance digestive. L’acte chirurgical, le type d’analgésie ou d’anesthésie utilisé, le type de réalimentation orale et son schéma de progression en sont des exemples. Les « interventions chirurgicales du système digestif » impliquant selon l’OFS l’oesophage, l’estomac, l’intestin grêle, le côlon, l’appendice, le rectum, l’anus, le foie, la vésicule et les voies biliaires ainsi que le pancréas font partie des interventions les plus pratiquées en Suisse. Pourtant, aucun consensus n’est établi entre les hôpitaux suisses concernant les protocoles de réalimentation après une chirurgie digestive. De nombreuses pratiques empiriques persistent malgré la tendance actuelle qui favorise une uniformisation des pratiques grâce aux protocoles ERAS®. Méthode : Une revue de littérature a été effectuée sur trois moteurs de recherche différents. Neuf essais cliniques randomisés (1-9) ont été sélectionnés et analysés. Des entretiens qualitatifs auprès de trois diététiciens et deux chirurgiens ont complété les résultats obtenus de la littérature et plusieurs similitudes ont pu être relevées. Résultats : Les données obtenues concernent en majorité les chirurgies intestinales et colorectales. Les symptômes et signes cliniques les plus communément cités sont les vomissements, les nausées et le passage de la première flatulence. En pratique, la tolérance digestive est systématiquement observée mais aucun protocole standardisé n’est utilisé pour son évaluation. Comme dans la littérature, les nausées et vomissements sont les items les plus souvent investigués. Discussion : L’hétérogénéité des définitions et des variables mesurant la tolérance digestive s’est confirmée. Depuis des dizaines d’années, de nouvelles preuves scientifiques contredisent les pratiques empiriques. Aujourd’hui les évidences ne sont plus en faveur des mises à jeun post-opératoires ou de la pose d’une SNG. Au contraire, les réalimentations précoces ont montré des bénéfices sur l’évolution clinique du patient opéré de la sphère digestive. Perspectives et conclusion : Une définition commune de la tolérance digestive amènerait un langage uniforme entre tous les professionnels de la santé. Cela permettrait de comparer les pratiques actuelles, favoriserait de nouvelles recherches sur le sujet afin d’optimiser et de standardiser les prises en charge des patients opérés de la sphère digestive. Cette évolution limiterait les pratiques empiriques et ainsi le risque de dénutrition et de carences nutritionnelles. Elle faciliterait également le travail interprofessionnel par la diminution du nombre de protocoles de prise en charge disponible. La tolérance digestive est, selon nous, un concept multifactoriel caractérisé par un ensemble de signes cliniques et symptômes induits par le fonctionnement digestif d’une personne. A long terme, d’autres études scientifiques englobant des localisations de chirurgies plus variées permettront d’établir une définition basée sur des évidences et bouleverseront le domaine de la chirurgie digestive et ses processus de soins nutritionnels

Swiss public health measures associated with reduced SARS-CoV-2 transmission using genome data

Genome sequences from evolving infectious pathogens allow quantification of case introductions and local transmission dynamics. We sequenced 11,357 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes from Switzerland in 2020 - the sixth largest effort globally. Using a representative subset of these data, we estimated viral introductions to Switzerland and their persistence over the course of 2020. We contrasted these estimates with simple null models representing the absence of certain public health measures. We show that Switzerland's border closures de-coupled case introductions from incidence in neighboring countries. Under a simple model, we estimate an 86-98% reduction in introductions during Switzerland's strictest border closures. Furthermore, the Swiss 2020 partial lockdown roughly halved the time for sampled introductions to die out. Last, we quantified local transmission dynamics once introductions into Switzerland occurred, using a phylodynamic model. We found that transmission slowed 35-63% upon outbreak detection in summer 2020, but not in fall. This finding may indicate successful contact tracing over summer before overburdening in fall. The study highlights the added value of genome sequencing data for understanding transmission dynamics

Understanding the experience in the healthcare system of non-migrant and migrant frequent users of the emergency department in French-speaking Switzerland: a comparative qualitative study

Background Previous research revealed the vulnerability of frequent users of emergency department (FUED) because of concomitant medical, psychological and social issues. Case management (CM) provides FUED with effective medical and social support, however, the heterogeneity of this population has highlighted the need to explore the specific needs of FUED subpopulations. In response, this study aimed to explore qualitatively the lived experience of migrant and non-migrant FUED in the healthcare system to identify unmet needs.Methods Adult migrant and non-migrant FUED (≥ 5 visits in the ED in the past 12 months) were recruited in a Swiss university hospital to collect qualitative data on their experience within the Swiss health system. Participants were selected based on predefined quotas for gender and age. Researchers conducted one-on-one semistructured interviews until reaching data saturation. Inductive conventional content analysis was used to analyse qualitative data.Results In total, 23 semistructured interviews were conducted (11 migrant FUED and 12 non-migrant FUED). Four main themes emerged from the qualitative analysis: (1) self-evaluation of the Swiss healthcare system; (2) orientation within the healthcare system; (3) relationship with caregivers and (4) perception of own health. While both groups were overall satisfied with the healthcare system and care provided, migrant FUED reported language and financial barriers to access it. Both groups expressed overall satisfaction over their relationship with healthcare professionals, although migrant FUED reported a feeling of illegitimacy to consult the ED based on social status, whereas non-migrant FUED felt more often the need to justify their use of the ED. Finally, migrant FUED perceived their own health to be affected by their status.Conclusion This study highlighted difficulties specific to subpopulations of FUED. For migrant FUED, these included access to care and impact of migrant status on own health. Adapting CM to the specific needs of migrant FUED could help reduce their vulnerability

Recherche sur la santé des populations vulnérables: enjeux et opportunités.

There is an important gap in health knowledge about vulnerable and hard-to-reach groups. The development of research projects and the implementation of interventions require strategies adapted to the particularities of these groups. This article reviews some of the main issues through the lens of recent projects conducted in French-speaking Switzerland

Smartphone-based secondary prevention intervention for university students with unhealthy alcohol use identified by screening: study protocol of a parallel group randomized controlled trial

Abstract Background Unhealthy alcohol use is a leading cause of morbidity and mortality among young people, including university students. Delivering secondary prevention interventions against unhealthy alcohol use is challenging. Information technology has the potential to reach large parts of the general population. The present study is proposed to test a proactive secondary prevention smartphone-based intervention against unhealthy alcohol use. Methods This is a parallel-group, randomized controlled trial (1:1 allocation ratio) among 1696 university students with unhealthy alcohol use, identified by screening and followed up at 3, 6, and 12 months. Participants will be randomized to receive access to a smartphone-based intervention or to a no intervention control condition. The primary outcome will be self-reported volume of alcohol drunk over the past 30 days, reported as the mean number of standard drinks per week over the past 30 days, measured at 6 months. Secondary outcomes will be number of heavy drinking days over the past 30 days, at 6 months. Additional outcomes will be maximum number of drinks on any day over the past 30 days, alcohol-related consequences (measured using the Short Inventory of Problems (SIP-2R), and academic performance. Discussion The aim of this trial is to close the evidence gap on the efficacy of smartphone-based secondary prevention interventions. If proven effective, smartphone-based interventions have the potential to reach a large portion of the population, completing what is available on the Internet. Trial registration ISRCTN, 10007691. Registered on 2 December 2019. Recruitment will start in April 2020

Developing a capacity-building intervention for healthcare workers to improve communication skills and awareness of hard of hearing and D/deaf patients: results from a participatory action research study

Abstract Background Healthcare workers (HCWs) are commonly not prepared to properly communicate with D/deaf and hard of hearing (HoH) patients. The resulting communication challenges reinforce the existing barriers to accessing and benefiting from quality of care in these populations. In response, this study aimed to develop and evaluate a capacity-building intervention for HCWs to raise their awareness of D/deaf and HoH individuals’ experiences in healthcare and improve their capacity to communicate with these populations. Methods This study featured a participatory action research design using qualitative and quantitative methods. The intervention was developed and tested through 4 iterative phases. Reactions (i.e., satisfaction and perception of the intervention content, quality, appropriateness and usefulness) were assessed quantitatively and qualitatively after the intervention, whereas perceived knowledge and self-efficacy in communicating with D/deaf and HoH patients and organizational payoffs (use frequency of basic rules and tools improving communication) were quantitatively assessed before, after and 6-month post-intervention. Results Main qualitative and quantitative findings showed that the final version of the intervention reached high levels of satisfaction among participants. Next, perceived knowledge and self-efficacy scores obtained after receiving the intervention and 6 months later were significantly higher than those yielded in the initial assessment, although both scores significantly decreased at 6 months (compared to the scores obtained just after the intervention). Finally, findings showed no significant changes in organizational payoffs after receiving the intervention. Echoing these results, main qualitative findings documented that after receiving the intervention, participants felt more confident yet not more equipped to communicate with D/deaf and HoH patients. Conclusions Findings suggest that the capacity-building intervention is a promising means to sustainably increase HCWs’ perceived knowledge and self-efficacy on how communicating with D/deaf and HoH patients, although complementary approaches and follow-up intervention reminders may be necessary to enable practice changes in the working environment