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Comparing indications, complexity and outcomes of laparoscopic liver resection between centers with and without a liver transplant program: a French nationwide study
No full textInternational audienceBackground: There are no data to evaluate the difference in populations and impact of centers with liver transplant programs in performing laparoscopic liver resection (LLR).Methods: This was a multicenter study including patients undergoing LLR for benign and malignant tumors at 27 French centers from 1996 to 2018. The main outcomes were postoperative severe morbidity and mortality.Results: A total of 3154 patients were included, and 14 centers were classified as transplant centers (N = 2167 patients, 68.7 %). The transplant centers performed more difficult LLRs and more resections for hepatocellular carcinoma (HCC) in patients who more frequently had cirrhosis. A higher rate of performing the Pringle maneuver, a lower rate of blood loss and a higher rate of open conversion (all p < 0.05) were observed in the transplant centers. There was no association between the presence of a liver transplant program and either postoperative severe morbidity (<10 % in each group; p = 0.228) or mortality (1 % in each group; p = 0.915).Conclusions: Most HCCs, difficult LLRs, and cirrhotic patients are treated in transplant centers. We show that all centers can achieve comparable safety and quality of care in LLR independent of the presence of a liver transplant program
Leaching of plasticizers from PVC medical devices: A molecular interpretation of experimental migration data
No full textInternational audienceHigh pressure liquid chromatography (HPLC) experiments and molecular simulations were combined to investigate the leaching process of DINCH, DEHT and TOTM plasticizers from PVC materials. Methodologies based on statistical thermodynamics were used to rationalize the migration of the different plasticizers in water and ethanolic solutions from different free energy contributions. We extended this combined approach to the study of the adsorption of a model drug (diazepam) on different plasticized-PVC materials. The drug loss by sorption was investigated in different solutions and rationalized at an energy level. The combination of experiments and theoretical approaches proved to be effective for these sophisticated systems and processes forwhich various energy contributions are involved
Allaitement maternel : évaluation de l’accompagnement proposé par les sages-femmes de patientes ayant un antécédent de cancer du sein
No full textIntroduction: women’s breast cancer is a reality today. Treatments initiated have numerous impacts on breast functionality. As a result, patients are confronted with breast-feeding difficulties. In the final analysis, it's essential to provide mothers with the support they need to make the transition to breastfeeding. The midwife, within the scope of her skills, supports mothers-to-be in their breastfeeding journey, both during pregnancy and after childbirth. Methods: this was a descriptive and interpretative qualitative study in which midwives who had already assisted patients with a history of breast cancer in their breastfeeding journey were interviewed using semi-directed interviews. The main objective was to evaluate the support offered during these breastfeeding projects.Results and Discussion: this study shed light on the support offered by midwives to these patients, adapted to the difficulties encountered, often moral, the divergent discourses of health professionals, but also technical, pain, cracks, engorgement. All of this was achieved by addressing the obstacles encountered by midwives, in terms of knowledge, information and recourse to help.Conclusion: midwives are the first line to support breastfeeding and can be called upon in special cases such as these. The importance of well-informed patients and their specialized support by competent professionals will help ensure the success of this wish.Introduction : les cancers du sein chez les femmes sont de plus en plus fréquents. Les traitements initiés ont de nombreux impacts sur la fonctionnalité du sein. Par conséquent, les patientes sont confrontées à des difficultés d’allaitement. Pour cela, un accompagnement soutenu et important se doit d’être mis en place afin d’encourager ces mères dans leur parcours. La sage-femme, dans ses compétences, accompagne les futures mères dans leur parcours d’allaitement maternel autant durant le suivi de la grossesse, qu’à la suite de l’accouchement.Méthode : il s’agissait d’une étude qualitative de type descriptive et interprétative d’entretiens semi-dirigés. La population interrogée se composait de sages-femmes ayant déjà accompagné des patientes avec un antécédent de cancer du sein dans leur parcours d’allaitement. L’objectif principal était d’évaluer l’accompagnement proposé lors de ces projets d’allaitement.Résultats et discussion : cette étude a permis d’éclaircir l’accompagnement proposé par les sages-femmes pour ces patientes, adapté aux difficultés rencontrées souvent morales telles que les discours divergents des professionnels de santé, mais aussi techniques, douleurs, crevasses, engorgements. Tout cela en faisant face aux obstacles rencontrés par les sages-femmes, en termes de connaissance, d’information et de recours à l’aide.Conclusion : les sages-femmes, en première ligne de l’accompagnement de l’AM, peuvent être sollicitées dans ces cas particuliers. L’importance de la bonne information des patientes et leur accompagnement spécialisé par les professionnels compétents se sont avérés en faveur de la réussite de ces allaitements
État des lieux de la prise en charge de la vulvodynie par des professionnels formés aux douleurs sexuelles
No full textIntroduction : Vulvodynia is a chronic vulvar pain affecting between 10 and 16% of today’s women.The main objective was to highlight the skills and role of each individual in the multidisciplinary management of vulvodynia, and more specifically on the midwife.Method : a qualitative descriptive and interpretive study was carried out using semi-structured interviews with 13 professionals trained in sexual pain in Auvergne-Rhône-Alpes. Results : each of the professionals felt the need for further training, with initial training remaining insufficient. A biological vulnerability and a source of daily pressure seem to accompany vulvodynia, characterized by chronic vulvar hypersensitivity. Reprogramming vulvar sensitivity is essential to reduce the body's hypervigilance. The perineum must also be relaxed to eliminate the hypertonia’s reflex, which is at at the root of chronic hypersensitivity. Midwives and gynecologists are called in to diagnose the condition and provide the necessary medical treatment. Paramedical professions are involved in screening, body relaxing and eliminating any additional sources of stress. A multidisciplinary approach would lead 80% of women to recovery and 100% of improvement.Discussion : feedback has highlighted the need for training, so it seems essential to incorporate more teaching on sexual pain into initial training. There is a gap between the latest French recommendations and current professional practices, hence the need to update these recommendations.Conclusion : the various specialties seem to complement each other in the treatment of vulvodynia. Given the extension of their skills and the characteristics of their patient base, midwives have an undeniable role to play in improving the quality of patient’s care.Introduction : la vulvodynie est une douleur vulvaire chronique touchant aujourd’hui entre 10 à 16 % des femmes. L’objectif principal était de mettre en lumière les compétences et le rôle de chacun dans le cadre de la prise en charge multidisciplinaire de la vulvodynie et plus spécifiquement celui de la sage-femme.Méthode : une étude qualitative de type descriptive et interprétative a été réalisée grâce à des entretiens semi-directifs auprès de 13 professionnels formés aux douleurs sexuelles en Auvergne-Rhône-Alpes.Résultats : une vulnérabilité biologique et une source de pression quotidienne semblent accompagner la vulvodynie, se caractérisant par une hypersensibilité vulvaire chronique. Une reprogrammation de la sensibilité vulvaire est essentielle afin de réduire l’hypervigilance du corps. Un relâchement du périnée doit y être associé afin d’éliminer l’hypertonie réflexe à l’origine de la chronicisation. Les sages-femmes, gynécologues semblent appelés pour poser le diagnostic et prodiguer les traitements médicamenteux nécessaires. Les professions paramédicales participent au dépistage, au relâchement corporel, et à l’évincement de toute source de stress surajoutée. Une prise en charge multidisciplinaire emmènerait 80 % des femmes sur le chemin de la guérison et 100 % d'amélioration.Discussion : le retour d’expérience a mis en évidence un besoin à se former, il semble donc essentiel d’intégrer plus d’enseignement sur les douleurs sexuelles à la formation initiale. Il existe un écart entre les dernières recommandations françaises et la pratique actuelle des professionnels, d'où la nécessité d'actualiser ces recommandations.Conclusion : les différentes spécialités semblent complémentaires dans le traitement de la vulvodynie. Au vu de l’extension de ses compétences et des caractéristiques de sa patientèle, la sagefemme a une place indéniable dans l'amélioration de la qualité de soin des patientes
The habitual degree of weight loss might be associated with specific fat and protein intakes during a period of weight maintenance in athletes used to weight variations: preliminary results from the WAVE study
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Use and consequences of less-lethal weapons in France: A neurosurgical perspective
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Morts maternelles par embolie amniotique en France 2016–2018
No full textInternational audienceAmniotic embolism remains the 3rd leading cause of maternal death in France, with 21 maternal deaths over the 2016–2018 triennium. The women who died were more likely to be obese (25%), to benefit from induction of labor (71%) and be cared in a maternity hospital < 1500 deliveries/year (45%), compared with the reference population (ENP 2016). The symptom occurred mainly during labor (95%) and the course was rapid, with a symptom-to-fatality interval of 4 hours 45 minutes (min: 25 minutes – max: 8 days). Preventability was proposed for 35% of the deaths assessed, with areas for improvement identified in terms of technical skills (haemostasis procedures, management of polytransfusion), non-technical skills (communication) and health care organization (human resources, vital emergency plan, wide access to PSL). An autopsy was performed in 38% of deaths.L'embolie amniotique reste la 3e cause de mort maternelle en France avec 21 décès maternels sur le triennium 2016–2018. Parmi les dossiers de femmes décédées on relevait plus souvent des patientes obèses (25 %), un travail déclenché (71 %) et une survenue dans une maternité de taille < 1500 accouchements/an (45 %), comparativement à la population de référence (ENP 2016). L'évènement survenait majoritairement au cours du travail (95 %) et l'évolution était foudroyante avec un délai symptômes–décès de 4 h 45 (min : 25 min – max : 8 j). Une évitabilité était proposée pour 35 % des décès expertisés avec des pistes d'amélioration relevées concernant les compétences techniques (gestes d'hémostase, gestion de la polytransfusion), les compétences non techniques (communication) et l'organisation des. soins (ressources humaines, plan urgence vitale, accès large aux PSL). Une autopsie était réalisée dans 38 % des décès
Adherence to resistance training and hypocaloric diet among persons near retirement age — A secondary data analysis of three randomized controlled trials
No full textInternational audienceObjectives: Adherence to lifestyle interventions is crucial for the treatment of obesity. However, there is little research about adherence to lifestyle interventions in persons around retirement age. The objectives of this study are (1) to identify factors associated with the adherence to resistance training and a hypocaloric diet and (2) to describe the association between adherence and changes in body composition outcome parameters. Design: This secondary data analysis included three randomized controlled trials. Setting & participants: The inclusion criteria of the participants were an age of 55-75 years, a BMI > 25 kg/m2 and receiving both a hypocaloric diet and resistance training. All participants were residing in the community. Measurements: Adherence to hypocaloric diet was measured through the mean dietary intake on the basis of a 3-day dietary record. If the participant consumed at least 600 kcal less than the individual caloric requirements, they were considered adherent. Adherence to resistance training was achieved if >67% of the recommended training sessions were attended over the course of the study periods. Results: 232 participants were included, 47.0% female, mean age 64.0 (+5.5) years. 80.2% adhered to resistance training and 51.3% adhered to a hypocaloric diet. Older age (Beta 0.41; 95% CI 0.05, 0.78; p = 0.028) and male sex (Beta 7.7; 95% CI 3.6, 11; p < 0.001) were associated with higher resistance training adherence. A higher BMI at baseline (Beta 6.4; 95% CI 3.6, 9.2; p <0.001) and male sex (Beta 65; 95% CI 41, 88; p <0.001) were associated with higher adherence to hypocaloric diet. Conclusion: We identified several associated factors (sex, age and BMI at baseline) that should be considered to promote adherence in future lifestyle intervention studies in persons around retirement age. We recommend including behavior change techniques in lifestyle interventions and consider sex-specific interventions to improve the adherence of women