Assessment of a multiprofessional training programme by in situ simulation in the maternity units of the Pays de Loire regional perinatal network.

INTRODUCTION: Initially dispensed in specialized simulation centers, simulation training has recently begun to take place directly in healthcare facilities, that is, in situ. The objective of this study is to assess the effect of training by in situ simulation in obstetrics. MATERIAL AND METHODS: The training program, dispensed over a 2-day period, took place in maternity units of the members of the Pays de la Loire perinatal network, Réseau Sécurité Naissance (Network Safety Birth). All participants received a learner satisfaction questionnaire to complete (5-point Likert-like scales). Then, at least 6 months later, each maternity ward received a general questionnaire to assess the effect of the training, as well as a second questionnaire specific to each institution, about the areas for improvement proposed by the teaching team after debriefings. RESULTS: The 14 establishments included in our study returned 375 satisfaction questionnaires. In all, 91.1 % were very satisfied and reported that the training met their expectations, and 99.7 % thought the program would have an impact on their professional practice. More than 94 % of the learners wanted more simulation sessions. Among the 14 facilities, 9 (64.3 %) returned their evaluation questionnaires. In 44.4 % of cases, they reported improvement in team cohesion and in team communication, while the others reported these elements remained stable. All maternity units reported that the training had a positive impact on their team, and that they would be interested in new training program with in situ simulation. DISCUSSION: Most participants clearly appreciated this training. In situ simulation training also led to the identification of areas for improvements, many of them accomplished, through the drafting of protocols or material modifications aimed at improving staff practices and therefore global patient care. There are many ways by which these training programs can be made sustainable, including the development of a new training program of in situ simulation or the creation of onsite simulation sessions on demand or by the professionals at each institution. CONCLUSION: This survey demonstrated the enthusiasm of healthcare professionals about in situ simulation. Moreover, overall improvement in team communication and cohesion was reported in the medium term (evaluation at more than 6 months). The interest of continuing these training sessions appears undeniable.

Pneumococcal urinary antigen test: A tool for pneumococcal aortitis diagnosis?

Introduction: Aortitis is rare. The etiological diagnosis is difficult but essential for treatment. Even with appropriate treatment mortality remains high. We present a case of pneumococcal aortitis followed by a brief review of the literature. Presentation of Case: In this case, the aortic disease was characterized by multiple inflammatory aneurysms. Blood cultures were negative but urine was tested for the presence of pneumococcal urinary antigen postoperatively was positive. Treatment consisted of antibacterial therapy and both surgical and endovascular procedures. The patient was discharged and is well. Discussion: Preoperative determination of etiology is crucial in implementing a specific treatment. Pneumococcus is a common bacterium in infectious aortitis. Identification of the causative microbe is necessary to guide antimicrobial therapy. Blood cultures are frequently sterile. The pneumococcal urinary antigen test may be more sensitive than blood cultures, as is the case in pneumococcal pneumonia. Conclusions: The pneumococcal urinary antigen test may was a useful diagnostic tool in establishing the cause for aortitis in this case. Its potential value should be assessed in furthers studies.

Retrospective study of anaesthetic management of pregnancy patients with mechanical heart valve prosthesis and anticoagulants.

Pregnancies among patients with a mechanical prosthetic valve and receiving anticoagulant medication are rare. Informations about their anesthetic management is poor. The objective of this study was to investigate the anaesthetic management of these patients in a reference medical centre as well as to identify possible ways for improvement. To this aim, the medical records of patients with a mechanical heart valve prosthesis having given birth at our center were analysed. In particular, the characteristics of patients and deliveries, the management of anticoagulation, as well as the type of anaesthesia performed, were collected and analysed. Eighteen cases were studied and compared to 36 controls. All studied cases were being administered anticoagulants. Five of these 8 patients delivered vaginally, one with epidural analgesia. Three of them have had a caesarean during labor, all under general anaesthesia. During the anticoagulation window, the teams had to perform an epidural in 3 (37%) of these 8 patients. Ten cases (55%) had a planned caesarean delivery, all performed under general anaesthesia. The anticoagulation interruption allowed spinal anaesthesia for 4 out of 10 caesarean delivery. The reoperation rate for secondary haemorrhage was significantly higher (P=0.0032) and the duration of the hospitalisation was extended (P<0.001). A context of anticoagulant overdose was identified in 60% of the bleeding cases. Progress can be made in the anaesthetic management of those patients by optimising the use of neuraxial anaesthesia and by improving the management of bleeding risk after delivery.