Les méningites bactériennes aigües communautaires de l'adulte en réanimation médicale (manifestations cliniques, prise en charge et facteurs pronostics)

Les méningites bactériennes aigues communautaires repésentent 12,6% des infections invasives en France avec une létalité importante. Nous avons comparé une série de 57 patients adultes admis en réanimation médicale au centre hospitalo-universitaire de Bordeaux pour une méningite bactérienne aiguë communautaire à des études réalisées 30 ans avant dans le même service. Il es es apparu que la mortalité n'avait pas significativement diminuée (31,6% vs 43% ; p=0,1) malgré l'apparition de nouvelles techniques de monitorage, de nouveaux antibiotiques et l'amélioration des techniques ventilatoires. Le maintien du taux de mortalité résulte de la modification du paysage bactérien avec l'augmentation de la prévalence de souches résistantes aux antibiotiques usuels (PSDP) et l'apparition de nouvelles molécules (céphalosporine de troisième génération, glycopeptide, etc). Nous avons rapprochés les résultats de notre étude avec ceux d'une étude espagnole réalisée en unité de soins intensifs portant sur 64 cas de méningites bactériennes communautaires de l'adulte dont la mortalité était significativment meilleure (19%). Le pronostic pourrait être amélioré par une surveillance en réanimation médicale plus précoce chez les patients présentant un ëge de plus de 60 ans, une immunodépression, une altération de la conscience ou une instabilité hémodynamique. La surveillance du niveau de conscience, le monitorage de l'hémodynamique et du débit sanguin cérébral permettraient d'anticiper le risque d'oedème cérébral et ses complications afin d'ajuster aux mieux les thérapeutiques parfois invasives (intubation à visée neuroprotectrice) tout en contrôlant leurs effets secondaires.BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Hydroxyzine for lowering patient's anxiety during prehospital morphine analgesia: A prospective randomized double blind study

International audienceStudy objective: Hydroxyzine is an antihistamine drug used for symptomatic relief of anxiety and tension. We hypothesized that managing the anxiety of patients with severe pain by adding hydroxyzine to a conventional intravenous morphine titration would relieve their pain more effectively.Methods: This was a randomized, double-blind, controlled group study of prehospital patients with acute pain scored greater than or equal to 6 on a 0-10 verbal numeric rating scale (NRS). Patients'anxiety was measured with the self-reported Face Anxiety Scale (FAS) ranking from 0 to 4. The percentage of patients with pain relief (NRS score ≤ 3) 15 min after the first injection was the primary outcome.Results: One hundred forty patients were enrolled. Fifty-one percent (95% CI 39% to 63%) of hydroxyzine patients versus 52% (95% CI 40% to 64%) of placebo patients reported a pain numeric rating scale score of 3 or lower at 15 min. Ninety-one percent (95% CI 83% to 98%) of patients receiving hydroxyzine reported no more severe anxiety versus 78% (95% CI 68% to 88%) of patients with placebo (p > 0.05). Adverse events were minor, with no difference between groups (6% in hydroxyzine patients and 14% in placebo patients).Conclusion: Addition of hydroxyzine to morphine in the prehospital setting did not reduce pain or anxiety in patients with acute severe pain and therefore is not indicated based on our results

Development and Evaluation of a Virtual Research Environment to Improve Quality of Care in Overcrowded Emergency Departments: Observational Study

International audienceBackground Despite a wide range of literature on emergency department (ED) overcrowding, scientific knowledge on emergency physicians’ cognitive processes coping with overcrowding is limited. Objective This study aimed to develop and evaluate a virtual research environment that will allow us to study the effect of physicians’ strategies and behaviors on quality of care in the context of ED overcrowding. Methods A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in emergency medicine combining virtual reality and simulated patients was designed and developed. Afterwards, 12 emergency physicians took part in simulation scenarios and had to manage 13 patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency, and mastering. The realism was the resemblance perceived by the participants between virtual and real ED. The consistency of the scenario and the participants’ mastering of the environment was expected for 90% (12/13) of the participants. Results The virtual ED was considered realistic with no significant difference from the real world with respect to facilities and resources, except for the length of time of procedures that was perceived to be shorter. A total of 100% (13/13) of participants deemed that patient information, decision making, and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios. Conclusions The new simulation tool, Virtual Research Environment in Emergency Medicine, has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared with real EDs and thus offers another way to study human factors, quality of care, and patient safety in the context of ED overcrowding

De l’art dramatique à l’art de l’entrevue médicale : retour d’une expérience auprès d’étudiants en médecine

Contexte : Tant l’enseignement du savoir-faire que celui du savoir-être, en particulier la communication médecin-patient peuvent être améliorés. Objectifs : Décrire et documenter l’intérêt des étudiants pour des dispositifs de formation à la communication et à la relation médecin-patient associant l’art dramatique et la simulation. Méthodes : Trente-trois étudiants en médecine (diplôme de formation approfondie en sciences médicales 1 et 2) ont participé à des ateliers de communication associant successivement une approche théâtrale comportant plusieurs exercices et une mise en situation professionnelle de communication en situation de consultation avec un patient simulé. Résultats : La grande majorité (92 %) des étudiants ayant participé à ces ateliers ont estimé que l’expérience leur a été bénéfique tant sur le plan du savoir-faire que du savoir-être et 94 % ont validé l’intérêt de ces ateliers pour leur pratique ultérieure. Les exercices théâtraux les plus plébiscités étaient l’histoire en cercle, l’histoire à plusieurs et l’histoire avec contrainte. Conclusion : L’association d’outils pédagogiques contextualisants, comme l’expérience théâtrale, le recours aux patients simulés en situation de problématiques cliniques fréquentes ou complexes, à des étudiants observateurs, le recours à la vidéo, et le débriefing entre les différents acteurs, recueille une très forte adhésion et détermine un grand bénéfice ressenti auprès des apprenants. Les résultats très positifs de cette expérience nous encouragent à étendre cette approche pédagogique intégrative à l’ensemble des étudiants du deuxième cycle des études médicales

Use of Screen-Based Simulation in Nursing Schools in France: A National, Descriptive Study

•Screen based simulation (SBS) most frequently conducted by students in pairs at school or alone at home.•SBS most frequently used for decision making and clinical reasoning.•SBS most likely to be used when leaders are trained in simulation.•Debriefing with an instructor is considered an essential element in SBS.•SBS was least used in mid-size nursing schools (100-200 students).•Most common barriers to implementation of SBS include cost and faculty development. Clinical simulation is a major component of undergraduate healthcare training. However, data are lacking regarding simulation modalities used in Europe. The purpose of this national study is to describe how screen-based simulation (SBS) is being used as well as identify the barriers to its use in nursing schools in France. This study employed a descriptive design with 207 nursing schools in France. Nursing school leaders (Deans, Heads of School, Simulation Coordinators or Leaders) were asked to complete an online survey. Traditional simulation was used in 92% of the nursing schools, but only 41% used SBS. Most nursing schools used SBS in a face-to-face format with students paired at a computer followed by a debriefing or alone at home. SBS is used mostly to teach decision making and clinical reasoning. SBS was used to complement traditional clinical time rather than replace it. Barriers included cost of SBS solutions, lack of recent computer equipment, high-speed internet network and training of the trainers. SBS is more frequently used in small nursing schools or large nursing schools where leaders are trained in simulation. Although simulation is broadly adopted by nursing schools in France, the use of SBS remains limited. Nurse leaders in mid-size nursing schools (with 100-200 nursing students) should consider investing more resources in SBS. A post-pandemic assessment is warranted

Does prior exposure to clinical critical events influence stress reactions to simulation session in nursing students: A case-control study

International audienc

Boot camp approach to surgical residency preparation: feedback from a French university hospital

International audienceAbstract Introduction The transition from medical student to surgical resident is not a simple one. The aim of this study was to report the experience of a university hospital in the organization of the induction course for future surgical residents and the contribution of a video support in the learning of the suture. Material and method We were able to study two consecutive years of students (October 2020 and 2021). Concerning the practical and technical workshops (learning suture) we carried out a comparative study between two groups of students. A group that had video support for learning suture (video group) and a group without video (control group). The evaluation of the suture was performed in a blinded manner by two supervising surgeons. The other practical workshop was drain fixation; the students did not have a video for this workshop. A comparative study was also performed for the drain fixation workshop between the two groups (video group and control group). A program of theoretical courses was also set up. This program is established according to the different future functions of the residents by integrating medico-legal notions and teamwork. Satisfaction questionnaires were given to the students and the answers were given two months after taking up their duties in the hospital (6 questions with Likert scale and 4 free questions). Results The cohort consisted of 58 students (29 each in 2020 and 29 in 2021). Comparative analyses of the evaluation of the suture workshops showed better performance in the video group compared with the group without video. The comparison of these two groups did not show significant differences in the drain fixation workshop. The theoretical teaching was broken down according to the students' future tasks and each speaker was a specialist in his or her field of expertise. The results of the questionnaires showed a desire on the part of the students to increase the time spent on practical workshops and theoretical forensic teaching. Conclusion We were able to show through these two years of a program that we were able to offer a surgical resident preparation course. In addition, we have highlighted the contribution of a video support in the learning curve of the suture

Mass Training In Situ During COVID-19 Pandemic

International audienc

Additional file 1 of Boot camp approach to surgical residency preparation: feedback from a French university hospital

Additional file 1

Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis

The effect of emergency department (ED) length of stay (EDLOS) on in-hospital mortality (IHM) remains unclear. The aim of this systematic review and meta-analysis was to determine the association between EDLOS and IHM. We searched the PubMed, Medline, Embase, Web of Science, Cochrane Controlled Register of Trials, CINAHL, PsycInfo, and Scopus databases from their inception until 14–15 January 2022. We included studies reporting the association between EDLOS and IHM. A total of 11,337 references were identified, and 52 studies (total of 1,718,518 ED patients) were included in the systematic review and 33 in the meta-analysis. A statistically significant association between EDLOS and IHM was observed for EDLOS over 24 h in patients admitted to an intensive care unit (ICU) (OR = 1.396, 95% confidence interval [CI]: 1.147 to 1.701; p 2 = 0%) and for low EDLOS in non-ICU-admitted patients (OR = 0.583, 95% CI: 0.453 to 0.745; p 2 = 0%). No associations were detected for the other cut-offs. Our findings suggest that there is an association between IHM low EDLOS and EDLOS exceeding 24 h and IHM. Long stays in the ED should not be allowed and special attention should be given to patients admitted after a short stay in the ED