L hystérectomie d hémostase dans l hémorragie du post-partum (impact clinico-biologique et retentissement psychologique)

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

La simulation obstétricale : du mannequin d'Angélique du Coudray aux Environnements Virtuels. Exemple d'un Simulateur numérique pour l'acquisition de Compétences Non-Techniques

International audienceCet article est divisé en deux parties. La première partie porte sur un état de l'art sur la simulation obstétrique. A partir d'un récapitulatif historique des innovations dans ce domaine, nous présentons les modèles physiques développés depuis la moitié du XVIIème siècle jusqu'aux Environnements Virtuels issus de l'ère de l'informatique et du numérique. Nous présentons dans un second temps un projet de recherche en cours de réalisation, portant sur l'intérêt des Environnements Virtuels pour la formation médicale en général et pour le développement, en situation critique, de Compétences Non-Techniques en particulier (communication, travail collaboratif, etc.). Pour cela, nous avons sélectionné comme objet d'étude une situation d'Hémorragie du Post Partum (HPP). Six scénarios ont été développés sur le logiciel PerinatSims 1 , afin de former les sages-femmes aux Compétences Non-Techniques

La simulation obstétricale : du mannequin d'Angélique du Coudray aux Environnements Virtuels. Exemple d'un Simulateur numérique pour l'acquisition de Compétences Non-Techniques

International audienceCet article est divisé en deux parties. La première partie porte sur un état de l'art sur la simulation obstétrique. A partir d'un récapitulatif historique des innovations dans ce domaine, nous présentons les modèles physiques développés depuis la moitié du XVIIème siècle jusqu'aux Environnements Virtuels issus de l'ère de l'informatique et du numérique. Nous présentons dans un second temps un projet de recherche en cours de réalisation, portant sur l'intérêt des Environnements Virtuels pour la formation médicale en général et pour le développement, en situation critique, de Compétences Non-Techniques en particulier (communication, travail collaboratif, etc.). Pour cela, nous avons sélectionné comme objet d'étude une situation d'Hémorragie du Post Partum (HPP). Six scénarios ont été développés sur le logiciel PerinatSims 1 , afin de former les sages-femmes aux Compétences Non-Techniques

Personal recovery of young adults with severe anorexia nervosa during adolescence: a case series

International audiencePurpose: Despite the emergence of a growing qualitative literature about the personal recovery process in mental disorders, this topic remains little understood in anorexia nervosa (AN), especially severe AN during adolescence. This cases series is a first step that aims to understand recovery after severe AN among adolescents in France, from a first-person perspective. Methods: This cases series applied the interpretative phenomenological analysis (IPA) method to data collected in semi-structured face-to-face interviews about the recovery process of five young women who had been hospitalized with severe AN 10 years earlier during adolescence. Results: A model of recovery in four stages (corseted, vulnerable, plastic, and playful) crossing seven dimensions (struggle and path of initiation; work on oneself; self-determination and help; body; family; connectedness; and timeline) emerged from the analysis. New features of the AN personal recovery process were characterized: bodily well-being and pleasure of body; stigmatization; the role of the group; relation to time; and importance of narratives. We suggest a new shape to model the AN recovery process, one that suggests several tipping points. Recruitment must now be widened to different AN contexts. Conclusions: The personal recovery paradigm may provide a new approach to care, complementary to medical paradigm. Registration of clinical trial: No. NCT03712384. Our study was purely observational, without assignment of medical intervention. As a consequence, this clinical trial was registered retrospectively. Level of evidence: Level V, descriptive study

A survey of the anesthetic management of pediatric kidney transplantation in France

International audienceBACKGROUND:Renal transplantation is the best available therapeutic option for end-stage renal failure in both children and adults. However, little is known about anesthetic practice during pediatric renal transplantation.MATERIAL AND METHODS:The study consisted of a national survey about anesthetic practice during pediatric renal transplantation in France. French tertiary pediatric centers performing renal transplants were targeted, and one physician from each team was asked to complete the survey. The survey included patient data, preoperative assessment and optimization data, and intraoperative anesthesia data (drugs, ventilation, and hemodynamic interventions).RESULTS:Twenty centers performing kidney transplantation were identified and contacted to complete the survey, and eight responded. Surveyed centers performed 96 of the 122 pediatric kidney transplantations performed in France in 2017 (79%). Centers consistently performed echocardiography and ultrasound examinations of the great veins preoperatively and consistently employed esophageal Doppler cardiac output estimation and vasopressors intraoperatively. All other practices were found to be heterogeneous. Central venous pressure was monitored in six centers, and dopamine was administered perioperatively in two centers.CONCLUSIONS:The current study provides a snapshot of the perioperative management of pediatric kidney transplantation in France. Results emphasize the need for both standardization of practice and awareness of recent evidence against the use of CVP monitoring and dopamine infusions

The impact of psychological factors on the management of intraoperative haemodynamic events in children

International audienceIntroduction: Paediatric anaesthesia requires specific theoretical knowledge and practical training. Non-technical skills and psychological factors might influence learning and practice. The aim of this study was to assess personality type and decision-making styles of paediatric anaesthesiology residents during the management of simulated intraoperative life-threatening cases.Method: Residents in anaesthesiology (between 4 and 5 years of training) participated in a simulated hypoxic cardiac arrest in the operating theatre. Their performance was evaluated using a score derived from international recommended management algorithm. They were asked to answer self-assessment questionnaires regarding both their personality (the five personality factors) and their decision-making style. Correlations between performance and personality were investigated.Results: Thirty-eight residents participated in the simulation session and 36 accepted to answer the questionnaires. Good management scoring was positively correlated with agreeableness and conscientiousness personality traits but was negatively correlated with avoidance and spontaneous decision-making styles.Discussion: The current study identified personality traits and decision-making styles that might influence the management of critical situations during paediatric anaesthesia. The proper identification of these factors might allow targeted personalised training to improve knowledge mobilisation and translation in the clinical context

Effectiveness of simulation in psychiatry for nursing students, nurses and nurse practitioners: A systematic review and meta-analysis

International audienceAims: Mental disorders constitute one of the main causes of disease and disability worldwide. While nurses are often at the frontline of mental health care, they have limited access to dedicated psychiatric training opportunities. Simulation training may foster the development of the appropriate competencies required when supporting people with mental disorders. To evaluate the effectiveness of simulation training in psychiatry for nursing students, nurses and nurse practitioners. Design: Systematic review and meta-analysis. Data sources: Eight electronic databases, trial registries, key journals and reference lists of selected studies were searched from inception to August 20, 2020 without language restriction. Review Methods: We included randomized and non-randomized controlled studies and single group pre/post studies. Cochrane Risk of Bias tool 2.0 was used for randomized controlled study appraisal, and the Medical Education Research Study Quality instrument was completed for all other studies. Meta-analysis was restricted to randomized controlled studies. The other studies were synthesized narratively. The main outcomes were based on Kirkpatrick levels. Results: A total of 118 studies (6738 participants) were found. Interventions included simulated patients (n = 55), role-plays (n = 40), virtual reality (n = 12), manikins (n = 9) and voice simulations (n = 9). Meta-analyses based on 11 randomized controlled studies found a significant large effect size on skills at immediate post-test for simulation compared with active control; and a small and medium effect size on learners’ attitudes for simulation compared with inactive control, at immediate post-test and at three-month follow-up respectively. Three quarters of non-randomized controlled studies and pre/post-tests assessing attitudes and skills showed significant differences, and three quarters of participants in randomized controlled studies and pre/post-tests showed significant differences in behaviours. Among the few studies assessing people with mental health outcomes, almost all reported significant differences. Conclusion: These findings support the effectiveness of simulation training in psychiatric nursing throughout professional development grades, despite heterogeneity in methods and simulation interventions