RESUMEN
OBJECTIVES: Communication breakdown is one of the main causes of adverse events in clinical routine. The main objective of this study was to assess whether a short training course on medical communication based on the situation-background-assessment-recommendation (SBAR) tool improved the quality of communication in clinical practice. METHODS: Interventional study, conducted at the Jeanne de Flandre maternity unit (Lille University Hospital, France) between January 2017 and December 2019. The training sessions lasted 1 hour and consisted of a theoretical part, based on the SBAR tool, and of a practical part (video-stimulated recall and role-play case scenarios). The main outcome measure was the evaluation of the quality of the telephone calls made by a caregiver to the on-call doctor, using a questionnaire completed before (Q1) and remotely from training (Q2). RESULTS: One hundred and twenty health professionals were trained (n=120). Following the trainings, there was an improvement in communication in the short term, whether in terms of relevance (64.9 vs. 52.6, P<0.001) or conciseness of the message (36.9 vs. 32.2, P<0.001), but also in terms of long-term in a real clinical situation (Q2: 3.9 vs. Q1: 3.0, P<0.001). Finally, 81% of participants were satisfied with the training. CONCLUSIONS: Short training sessions on communication based on the SBAR tool appeared to improve participants' knowledge and skills in the short-term, but also in the longer term in a real clinical situation.
Asunto(s)
Cuidadores , Médicos , Comunicación , Femenino , Francia , Humanos , Embarazo , Encuestas y CuestionariosRESUMEN
To better understand the in vivo mechanical behavior of synthetic mesh implants, we designed a specific experimental protocol for the mechanical characterization of explanted mesh under uniaxial tension. The implantation of a mesh leads to the development of scar tissue and the formation of a new composite made of native tissue, a mesh implant and scar tissues. This study focused on three points: determining the minimum representative size of mesh implants required for mechanical test samples, highlighting the influence of healing, and defining the healing time required to ensure stabilized mechanical properties. First, we determined the minimum representative size of mesh implants for the mechanical characterization with a study on a synthetic composite made of mesh and an elastomeric matrix mimicking the biological tissues. The size of the samples tested was gradually decreased. The downsizing process was stopped, when the mechanical properties of the composite were not preserved under uniaxial tension. It led to a sample representative size 3cm long and 2cm wide between the grips. Then an animal study was conducted on Wistar rats divided into eight groups. One group was set as control, consisting of the healthy abdominal wall. The other seven groups underwent surgery as follows: one placebo (i.e., without mesh placement), and six with a mesh installation on the abdominal wall and healing time. The rats were sacrificed after different healing times ranging from 1 to 5 months. We observed the influence of healing and healing time on the mechanical response under uniaxial tension of the new composite formed by scar, native tissue, and textile. It seems that 2 months are required to ensure the stabilization of the mechanical properties of the implanted mesh. We were not able to tell the control group (native abdominal wall) from the placebo group (native and scar tissue). This protocol was tested on two different prostheses after 3 months of healing. With this protocol, we were able to differentiate one mesh from another after host integration.
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Prótesis e Implantes , Mallas Quirúrgicas , Cicatrización de Heridas , Pared Abdominal , Animales , Materiales Biocompatibles , Fenómenos Biomecánicos , Cicatriz , Ratas , Ratas WistarAsunto(s)
Cistocele/cirugía , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Cabestrillo Suburetral/efectos adversos , Mallas Quirúrgicas/efectos adversos , Uréter/lesiones , Incontinencia Urinaria de Urgencia/etiología , Prolapso Uterino/cirugía , Anciano , Femenino , Humanos , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/etiología , Resultado del Tratamiento , Uréter/diagnóstico por imagen , Incontinencia Urinaria de Urgencia/diagnóstico por imagenRESUMEN
OBJECTIVE: Evaluate the place of sub-urethral mini-slings in the treatment of female stress urinary incontinence. MATERIAL AND METHODS: Review of the literature on 43 publications (comparative and prospective studies) more than 6443 patients who underwent for the treatment of urinary incontinence, a mini-strip type TVT®, TVT-S®, MiniArc®, Ajust®, Needleless®, Solyx®, or Ophira® in comparison to the conventional urethral sling. The comparison used objective (cough stress test and pad weight test) and subjective criteria (quality of life questionnaire). The papers have also studied the complication associated with these new techniques. RESULTS: The overall effectiveness of this surgery varied between 40 to 84% for TVT-S®, 69 to 92% for MiniArc®, 80 to 91% for Ajust®, 87% for Needleless®, 95% for Solyx® and 85% for Ophira®. The efficacy on incontinence was higher with the TVT® TVT-S® and the MiniArc® (P=0.01 to 0.05). TVT-O® efficacy was higher than TVT-S® (P<0.01 and P=0.02). Conventional slings seems to be more efficient than TVT-S® and MiniArc® mini-slings. Ajust® mini-sling seems to be as efficient as MiniArc® and TVT-S® mini-sling and TVT-O®. It showed a decrease in the intensity of postoperative pain (P<0.001), faster return to normal activities (P=0.025) and use of a common local anesthetic to the adjustable mini-sling. CONCLUSION: It seems that the adjustable mini-sling is currently the best compromise in terms of effectiveness and complications if the choice had to be among the mini-sling in the treatment of stress urinary incontinence.