Positive impact of simulation training of residents on the patients' psychological experience following pregnancy loss.

OBJECTIVE: Our study aimed to assess the impact of a simulation training program for residents for the disclosure of diagnosis on the psychological experience of couples following a first trimester pregnancy loss (PL). METHODS: We performed an uncontrolled prospective single center, before-after study, at the gynecological emergency department of Angers University Hospital in France, between May 2014 and April 2015. We included all patients who had a confirmed diagnosis of first trimester PL. A self-administering questionnaire (SAQ) that included the short version of the perinatal grief scale (PGS) and questions about the couples' personal experience was sent by mail 8 weeks after the diagnosis. Patients were included before and after simulation training of the residents on the communication of the diagnosis of PL, and scores were compared between the two groups (before and after training). RESULTS: Overall 72 patients fulfilled the inclusion criteria and responded to the SAQ, 45 before and 27 after simulation training. Overall, simulation training significantly lowered the overall PGS (39.4±4.9 vs 57.3±5.6, p=0.03), significantly improved the attitude of the resident when announcing the diagnosis (more considerate (74.1 % vs 48.9 %, p=0.04) and available (59.3 % vs 28.9 %, p=0.01)), and significantly improved the quality of the information given (less incomprehensible (22.2 % vs 46.7 %, p=0.04). Finally, significantly fewer patients reported needing an additional consultation for further information following training (33.3 % vs 73.3 %, p=0.01). CONCLUSION: Simulation training of residents for the disclosure of early pregnancy loss significantly improves the couples' personal experience and decreases the psychological morbidity associated with the communication.

[Psychology and pregnancy loss]. / Psychologie et perte de grossesse.

OBJECTIVE: The objective of this study was to evaluate the relationship between psychology and pregnancy loss. METHODS: A literature review was conducted by consulting Medline until April 2014. RESULTS: Psychological factors appear to be significantly associated with the risk of recurrent miscarriage. Depression and anxiety are common symptoms after miscarriage. A return to normal scores of depression and anxiety is frequently found in one year. A systematic psychological treatment after an episode of miscarriage seems to not bring obvious benefits, one year after a miscarriage, in terms of anxiety and depression. After a stillbirth, psychological impacts on the couple, such as anxiety and depressive symptoms, are common. An empathetic and respectful attitude of all medical and paramedical team at the support is associated with better psychological experience. CONCLUSION: After a pregnancy loss, psychological consequences are common and usually reversible. An attitude of empathy is desirable in order to accompany patients and to consider a future pregnancy.

Simultaneous determination of enrofloxacin and ciprofloxacin in animal biological fluids by high-performance liquid chromatography. Application in pharmacokinetic studies in pig and rabbit.

A simple and rapid high-performance liquid chromatographic method for the simultaneous determination of enrofloxacin and ciprofloxacin has been developed in pig and rabbit samples. Solid-phase extraction was applied from samples on a C18 cartridge using a mixture of methanol-hydrochloric acid (98:2, v/v). Analytical separation was performed on a C18 column with UV detection at 277 nm under gradient conditions. The mobile phase was a mixture of orthophosphoric acidtriethylamine-acetonitrile. The method has been validated for both molecules in pig and rabbit plasma and adapted for rabbit tissue-cage fluid (TCF). The assay is specific and reproducible within the both drugs and mean recoveries for ciprofloxacin and enrofloxacin, respectively, were 92+/-6% and 90+/-5% for pig plasma over the range used. Mean recoveries for enrofloxacin were 108+/-9% and 102+/-7% for rabbit plasma and TCF, respectively, over the range used. The suitability of the assay for pharmacokinetic studies was determined by measuring enrofloxacin and ciprofloxacin concentrations either in pig plasma after administration of a single intravenous 5 mg/kg dose of enrofloxacin or in rabbit plasma and TCF during a 24 h infusion of enrofloxacin at a rate of 1.25 mg/kg per hour.

[Bactericidal effect of colistin on Escherichia coli. Model and simulation or the pharmacokinetic-pharmacodynamic relation for prediction of efficacy in veterinary antibiotic therapy]. / Effet bactéricide de la colistine vis-à-vis d'Escherichia coli. Modélisation et simulation de la relation pharmacocinétique-pharmacodynamique pour la prédiction de l'efficacité en antibiothérapie vétérinaire.

Pharmacodynamics studies consider three main parameters: the size of the bacterial population, the concentration of the antibiotic and the duration of its action. The pharmacodynamic characteristics of colistin were studied in vitro with Escherichia coli. The bacterial kinetics were fitted using differential equations. The mathematical model gave qualitative and quantitative information about the characteristics of the antibiotic-bacteria association. Above all, when linked to a pharmacokinetic model, the model permitted the prediction of the drug's efficiency. Simulations of various dosage levels in which the administration route, dose size, or interval between doses varied, permitted a more rational optimization than a prediction of efficacy based on the time taken to achieve antibiotic plasmatic concentrations above the minimal inhibitory concentration. Pharmacokinetic/pharmacodynamic modeling seems to be an interesting possibility for determining antibiotic dosing levels during the preclinical phase.