Factors of adjustment of military personnel in peacekeeping operation

Belgian military personnel have been sent to peacekeeping operations since approximately 15 years. Up to now, almost no scientific work has been conducted to know the factors of adjustment of servicemen at all stages of the deployment within the Belgian Army. Psychological literature strongly emphasizes PTSD as the principal adjustment factor during peacekeeping times. We conducted focus-groups in March and April 2004 with expeacekeepers to investigate which psychological variables they found interesting to study. The model we developed encompasses three variables military personnel discussed, namely (1) the affective bonds between them and significant others/family back home in Belgium (adult attachment); (2) the affective bonds between them and members of heir work group (group attachment), and (3) the question of the leader (perfectionism, psychological control). Moreover, several factors of adjustment will also be taken into account. We retained symptoms (depression, anxiety), well-being, and relational variables (self-esteem and social support). Intervening variables in the relationship between relationship variables (adult and group attachment), personality (perfectionism, psychological control, dependency/self- criticism) and adjustment factors will also be investigated: namely ad hoc groups, group cohesion, perceived stressfulness of the mission, life stress, and the repetition of the missions. Six longitudinal studies will be conducted, involving each a minimum of more or less 500 peacekeepers. We will first measure each variable of interest four months before deployment, when new groups of peacekeepers are formed. The second wave will happen two months after deployment. The fourth and the sixth wave of measurement will occur four and twelve months after deployment, respectively.status: publishe

Transcutaneous posterior tibial nerve stimulation (TPTNS) in managing urinary incontinence

peer reviewedUp to 25% of women may be affected by urinary incontinence. Peripheral stimulation of posterior tibial nerve in the retromalleolar region can be proposed in certain cases of urinary incontinence. in this report, we conducted a follow-up on 268 patients suffering from incontinence and treated by the means of neuromodulation. The study analysis demonstrated significant success rates in patients with stress urinary incontinence, as well as in those with mixed incontinence.L’incontinence urinaire peut être présente jusqu’à chez 25% des femmes. La neuromodulation périphérique du nerf tibial postérieur rétromalléolaire interne est une technique proposée pour le traitement de cette incontinence. Nous proposons dans cette étude un suivi de 268 patients avec incontinence ayant bénéficié de cette thérapie. Celle-ci révèle un taux de succès significatif chez les patients avec incontinence urinaire par instabilité pure ou incontinence mixte

Seromas and punctures after complete axillary node dissection for breast cancer: differences between mastectomy and lumpectomy

info:eu-repo/semantics/publishe

Rocuronium-Magnesium Association for Rapid Sequence Induction: More Than a Question of Doses

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Sermons de M. Massillon, évêque de Clermont ...

Les 2 mencions de publicació són agrupades per una clau després de "chez"Menció d'impressió obtinguda del colofóNombre de vol. deduït d'altres edicions de l'èpocaNomés s'indiquen les seqüències numerades de paginacióVol. [1]: xxxij, 337 p.; vol. 2: 459 p.; vol. 3: 485 p.Postil·les i reclamsFrisos, vinyetes i caplletres ornadesConté (a port.): 1. Petit-Careme -- 2 i 3. Carêm

Continuous Ropivacaine Subfascial Wound Infusion Compared with Intrathecal Morphine for Postcesarean Analgesia: A Prospective, Randomized Controlled, Double-Blind Study

BACKGROUND: After cesarean delivery, postoperative pain management allows early rehabilitation and helps prevent postpartum depression and chronic pain. Our present prospective, randomized controlled, double-blind study assessed the duration and effect of intrathecal analgesia and continuous ropivacaine wound infiltration versus a control group after cesarean delivery. The primary outcome was analgesia duration, defined as time to first morphine request. Secondary outcomes were cumulative postoperative morphine consumption, number of patients who did not require IV morphine, incidence of adverse effects, and time to first ambulation. METHODS: A total of 192 full-term parturients undergoing elective cesarean delivery were randomly allocated into 3 groups (control, morphine, and catheter). All patients received spinal anesthesia with 10 mg bupivacaine 0.5% hyperbaric bupivacaine (2 mL) + 5 μg of sufentanil (1 mL) and a multiholed catheter inserted into the wound. In the control group, NaCl 0.9% was administered intrathecally (0.1 mL) and through the catheter. The morphine group received 100 μg morphine (0.1 mL) intrathecally and NaCl 0.9% infused through the wound catheter. The catheter group received 0.1 mL NaCl 0.9% intrathecally and ropivacaine 0.2% infused in the catheter. Each patient received a 15-mL bolus of the dedicated solution through the catheter, which was connected to an elastomeric pump infusor delivering the same solution at a rate of 10 mL/h for 30 hours. All patients also received multimodal analgesia including acetaminophen and diclofenac. Analgesia duration was defined as the time from spinal injection (T0) to first IV morphine requirement (T1) administered via a patient-controlled IV analgesia pump. Statistical data analyses included use of the Kruskal-Wallis rank-sum test followed by the post hoc Tukey test and χ2 test. RESULTS: The duration of postoperative analgesia was increased with intrathecal morphine (380 minutes; 215-1527) and ropivacaine wound infusion (351 minutes; 227-594) compared with the control (247 minutes; 182-338) with effect sizes of 0.171 (0.043-0.293) for morphine versus control and 0.164 (0.052-0.271) for catheter versus control. There was no difference between the morphine group and catheter group (effect size, 0.007; -0.118 to 0.132). Cumulative postoperative morphine consumption was also significantly lower in the morphine group and catheter group compared with the control group. The incidence of adverse effects did not differ between groups. CONCLUSIONS: After elective cesarean delivery, 100 μg intrathecal morphine and ropivacaine wound infusion both increased the duration and effect of postcesarean analgesia without increased incidence of side effects.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Neuromuscular block in patients 80 years and older: a prospective, controlled study

Background: An increasing number of patients older than 80 years are undergoing anesthesia, but little information is available regarding pharmacodynamic effects of myorelaxants in this population. This study aims to compare the time course of rocuronium neuromuscular block in patients ≥ 80 years with those of younger adults. Methods: Under total intravenous anesthesia with propofol and sufentanil, time course of a bolus of rocuronium 0.6 mg/kg neuromuscular block was assessed with acceleromyography in patients ≥ 80 and in patients 20–50 years old. Onset time, clinical duration, duration until 90% and 100% recovery of baseline were determined. Results: Data from 32 patients were analyzed, 16 were ≥ 80 years and 16 were 20–50 years old. Demographic data are shown in Table 1. In the group ≥ 80, onset time was 190 s ± 46 s compared to 123 s ± 40 s in the group 20–50, P < 0.001 and the clinical duration was 52 [48–69.5] min and 36 [34–41] min, respectively, P < 0.001. Duration to 90% recovery of baseline was 77.5 [71–88.5] min and duration to 100% recovery of baseline was 91.2 [82.2–98] min in patients ≥ 80 years and the corresponding values in the patients 20–50 years old were 53.5 [49–55.5] min and 59.5 [56.5–70.25] min, respectively, P < 0.001. Conclusion: Compared to younger adults rocuronium shifted in patients ≥ 80 years from a rapid onset, intermediate acting compound to a slower onset, long-acting compound. Trial registration: ClinicalTrials.gov identifier: NCT03551652 (29/05/2018).SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Pulmonary valve replacement after right ventricular outflow tract reconstruction with homograft vs Contegra®: A case control comparison of mortality and morbidity

Background: Repair of congenital heart defects involving the right ventricular outflow tract may require the implantation of a right ventricle to pulmonary artery conduit. This conduit is likely to be replaced during childhood. This study compares the operative outcomes of the replacement procedure of Contegra® and homografts in pulmonary position. Methods: From 1999 to 2016, 82 children underwent 87 right ventricle to pulmonary artery conduit replacements (60 Contegra® and 27 homografts). Demographics, operative and clinical data were obtained through a retrospective review of the medical records. The two groups were matched for comparison using propensity score matching. All the procedures were performed by the same team of surgeons. Results: No statistically significant difference was observed between the two groups when considering the operative data for anesthesia, surgery, cardiopulmonary bypass and aortic clamping durations. A peroperative complication rate of 13.47% and 15.36% in Contegra® and homograft replacement groups respectively (p value = 0.758) was observed. There was no difference regarding the blood loss and fluid input. No statistically significant difference was observed between the two groups for the post-operative morbidity. We considered the Pediatric Risk of Mortality (PRISM) score, the day of extubation, the day of withdrawal of inotropic drugs, the length of the intensive care unit stay and the length of hospital stay. The overall mortality is 2.3% but there is no statistically significant difference between the two groups. Conclusion: Right ventricle to pulmonary artery conduit replacement procedure can be achieved with a low surgical morbidity or mortality, not influenced by the type of conduit that is replaced. Therefore, the choice between homograft or Contegra® for right ventricle to pulmonary artery reconstruction should not be influenced by the future surgical risk during the replacement procedure. Trial registration:NCT03048071. Registered 9 February 2017 (retrospectively registered).SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Sufentanil sublingual tablet system versus oral oxycodone for management of postoperative pain in enhanced recovery after surgery pathway for total knee arthroplasty: a randomized controlled study

Purpose: Effectiveness of sufentanil sublingual tablet system (SSTS) compared to oral oxycodone in the management of postoperative pain after total knee arthroplasty (TKA) within an enhanced recovery after surgery (ERAS) protocol. Methods: This pragmatic, parallel, open label, randomized controlled, trial enrolled 72 adult patients scheduled for TKA under spinal anesthesia following ERAS pathway. In addition to multimodal analgesia, patients received SSTS 15 mcg (SSTS group) or oral oxycodone extended release 10 mg twice daily and oral oxycodone immediate-release 5 mg up to four times daily on demand (Oxy group) to control pain during 48 h postoperatively. The primary endpoint was pain measured using a numeric rating scale at 24 h postoperatively. Time to first mobilization, side effects and patient satisfaction were also recorded. Results: Median pain score at 24 h at rest was 3 [2–4] for Oxy group vs 2 [1.75–3] for SSTS group (p = 0.272) whereas median pain score on movement was 4 [3–6] vs 3 [2–5] respectively (p = 0.059). No difference in time to first mobilization was found between the two groups. The method of pain control was judged good/excellent for 83.9% of patients in the SSTS group compared with 52.9% in the Oxy group (p = 0.007). The incidence of nausea was 33% in SSTS group and 9% in Oxy group (p = 0.181). Conclusions: In complement to ERAS multimodal analgesia, sublingual sufentanil 15 mcg tablet system did not show clinically significant pain improvement compared to oral oxycodone after total knee arthroplasty. Trial registration: Clinical Trials: NCT04448457; retrospectively registered on June 24, 2020. https://clinicaltrials.gov/ct2/show/NCT04448457?cond=sublingual+sufentanil&cntry=BE&draw=2&rank=3.SCOPUS: ar.jinfo:eu-repo/semantics/publishe