The place of scientific knowledge in the teaching of technical skills in initial nursing training: a descriptive qualitative study / Place des savoirs scientifiques dans l'enseignement des gestes techniques en formation infirmière initiale : une étude qualitative descriptive

Context: Universitarization and the nursing education reference system encourage the use of scientific knowledge and the integration of evidence into clinical practice. Students in initial training are trained in technical gestures. On what knowledge are they based? Objective: The main objective of this study is to identify the knowledge utilised by nurses and trainers to teach technical nursing procedures. Method: A descriptive qualitative study was carried out using semi-directed interviews with 16 participants. Results: The teaching of nursing skills is mainly based on local or authoritative knowledge. Trainers and nurses who display scientific knowledge update their practices and education more easily. As in health care services, the lack of knowledge and training in evidence-based medicine and the use databases, as well as the lack of English language skills, are the major obstacles to teaching technical procedures based on scientific knowledge. Discussion: The use of scientific data in the learning of technical procedures during initial training could legitimate the knowledge taught, develop the students’ critical thinking and encourage their autonomy in the face of protocol injunctions and service habits.

Contexte: L'universitarisation et le référentiel de la formation infirmière favorisent l'utilisation de savoirs scientifiques et l'intégration des données probantes dans la pratique clinique. Les étudiants en formation initiale sont formés aux gestes techniques. Sur quels savoirs se basent-ils ? Objectif: L'objectif principal de cette étude est d'identifier les savoirs mobilisés par les infirmiers et les formateurs pour enseigner les gestes techniques infirmiers. Méthode: Une étude qualitative descriptive a été menée à l'aide d'entretiens semi-dirigés auprès de 16 participants. Résultats: Les enseignements des gestes techniques se basent principalement sur des savoirs locaux ou issus de l'autorité. Les formateurs et les infirmières qui mobilisent les savoirs scientifiques réactualisent plus facilement leurs pratiques et leurs enseignements. Comme dans les services de soins, le manque de connaissance et de formation concernant les données probantes et l'utilisation des bases de données ainsi que la maîtrise de l'anglais sont les freins majeurs à l'enseignement des gestes techniques à partir de savoirs scientifiques. Discussion: La mobilisation de données scientifiques dans l'apprentissage des gestes techniques en formation initiale pourrait légitimer les savoirs enseignés, développer la pensée critique des étudiants, et favoriser leur autonomie face aux injonctions protocolaires et aux habitudes de service.

[SUPPORT, CO-OPERATIVE EDUCATION PROGRAMMES, PRAGMATIC CODE OF ETHICS: A CLINICAL APPROACH OF EXECUTIVE TRAINING]. / ACCOMPAGNEMENT, ALTERNANCE ET ÉTHIQUE PRAGMATIQUE: VERS UNE DÉMARCHE CLINIQUE DE FORMATION.

This article aims at introducing an educational sequence completed at l'Institut de Formation des Cadres de Santé (IFCS) at the CHRU in Lille in France, entitled "training project and educational project" present in the "training duties" module whose goal is to generate students'knowledge through co-operative education programmes. By creating this innovative sequence, the educational aim is to use the Institut ground as a ground of learning, associated with the various internship grounds, in order to get the most of co-operative education programmes. Besides, in a pragmatic code of ethics in training, the teaching staff draw their inspiration from a clinical approach of executive training: they regard students as true protagonists in a co-operative plan created for them, wishing to design it with them using their words. Thus, students are brought to criticize the IFCS educational project and debate it with the trainers who have built it. Each partner tries to understand the Other, being aware of their being different. By contributing every year to rewriting the educational project which directly concerns them, students build their professional positions as health executives. They play an active role in co-operative education programmes just like IFCS outside partners.

Is systematic scalene node biopsy in pretreatment evaluation of locally advanced cervical carcinoma necessary? Systematic dissection and histopathology of left scalene node biopsies in patients with locally advanced cervical carcinoma.

OBJECTIVE: Cervical carcinomas mainly spread via lymphatics, stepwise from pelvic to aortic and scalenic lymph nodes. Metastatic nodes are the major prognostic factor in this disease. When scalenic nodes are involved, cervical cancer is considered to be disseminated. Since there is a major discrepancy in reported percentages of metastatic scalene nodes in the literature (0 to 50%), we proceeded to systematic pretreatment scalene node biopsy and then evaluated the validity of this procedure. METHODS: From January 1998 to May 2003, 72 patients with locally advanced cervical carcinoma and no suspicious paraaortic or scalenic nodes (respectively on magnetic resonance imaging and clinically) had a systematic surgical pretreatment lymph node evaluation (retroperitoneal laparoscopic infrarenal paraaortic lymph node dissection and left scalenic lymph node biopsy). Scalene biopsy was examined using hematoxylin/eosin stain and immunohistochemistry (KL1 antibodies). RESULTS: Among the 72 patients, 20 were stage IB2, 4 were IIA, 14 were IIB, 4 were IIIA, 27 were IIIB, 1 was IVA and 2 had a recurrent cervical carcinoma. Fourteen women had histologically confirmed paraaortic metastases (11 macroscopic, 3 microscopic). No metastatic involvement of the scalene nodes was detected. Fifteen patients developed a recurrence within 12 months (3 to 19 months). None of the patients developed scalenic recurrence. CONCLUSION: Left scalene node biopsy does not appear to be mandatory in routine pretherapeutic lymph node evaluation of patients with advanced cervical carcinoma and no clinical suspicious nodes. It may be useful to prove disseminated disease in patients with suspicious clinical nodes or hot spots on PET-scan, if fine needle biopsy is unconclusive.

[Breast adenocarcinoma: critical analysis of sentinel lymph node histopathological results of 542 procedures]. / Adénocarcinomes mammaires: analyse critique des résultats histopathologiques des ganglions sentinelles, à propos de 542 cas.

Between February 2001 and March 2003, 542 sentinel lymph node procedures were performed for localised breast carcinoma (T0-T1, N0, M0) without any previous treatment. Frozen sections were performed in 515 cases and they did not reveal metastases in 446 cases. Fifty-two micrometastases < 2 mm and 18 macrometastases were reported by definitive histopathological exam. Axillary clearance was performed in 50/70 patients (38 with micrometastases and 12 for macrometastases). Modalities of histopathological procedure are discussed and particularly number and interval of serial slides with or without immunochemistry ; 81.8% (36/44) of micrometastases were detected on the two first serial sections. Decisional value of axillary clearance performed in case of micrometastases is also evaluated.

Prognostic value of ERM gene expression in human primary breast cancers.

We measured the expression of ERM gene, a nuclear transcription factor belonging to the ets family, in a series of 364 unselected primary breast cancers from patients who underwent locoregional surgery in the Centre Oscar Lambret between May 1989 and December 1991. The expression of ERM was quantified with a real-time one-step reverse transcription-PCR assay based on the 5'-nuclease activity of the TaqDNA polymerase and with an Abi Prism 7700 Sequence Detector System (Applied Biosystems, Courtaboeuf, France). ERM was positively correlated (Spearman test) to epidermal growth factor receptor (EGFR; P < 0.001, r = 0.296) and to histoprognostic grading (P = 0.044, r = 0.112), whereas it was negatively correlated to estradiol receptors (P = 0.019, r = -0.124), HER3 (c-erbB-3; P = 0.01, r = -0.135), and HER4 (c-erbB-4; P = 0.003, r = -0.154). Using the chi2 test, a positive relationship was found between the expression of ERM and EGFR (chi2 = 7.795, P = 0.007). In overall survival studies, Cox univariate analyses demonstrated a prognostic value of ERM (P = 0.006; risk ratio, 2.95) besides the classical prognostic factors histoprognostic grading, node involvement, tumor size, estradiol receptors, progesterone receptors, EGFR, HER3, and HER4. In multivariate analyses, ERM preserved its prognostic value (P = 0.004; risk ratio, 3.779) together with histoprognostic grading, tumor size, estradiol receptors, and progesterone receptors. In relapse-free survival studies, univariate analyses demonstrated that histoprognostic grading, node involvement, tumor size, and HER4 were prognostic factors. These parameters, except histoprognostic grading, retained their prognostic value in multivariate analyses. This study demonstrates for the first time that ERM gene expression is an independent adverse prognostic factor for overall survival in breast cancer patients.

[MR imaging of endometrial carcinoma: role and limits]. / IRM des cancers de l'endomètre: apports et limites.

PURPOSE: To assess the MR imaging (MRI) in initial decision making of endometrial carcinoma. PATIENTS AND METHODS: From january 1997 to march 2002, 86 patients with clinical stage I endometrial carcinoma were studied by pelvic (22) or abdomino-pelvic (64) MRI. The size and signal of lesions and junctional zone, the enhancement after contrast administration, the associated benign lesions and the pelvic and lumbo-aortic lymph nodes were assessed without knowledge of surgical results in viewing to identify pitfalls in MRI staging. RESULTS: MRI allows correct staging in 81.4% (70/86) of cases. Nine cases of false negative on T2 weighted images were correctly staged after contrast administration and dynamic study. Limits of MRI are due to presence of thin or lack of junctional zone, polyps, myomas, adenomyosis, intra cavitary bleeding, and myometrium thinning by large tumors. Eighteen patients were N+, with MRI sensitivity of 82% and specificity of 94%. CONCLUSION: MRI is the best modality for pretherapeutic assessment of endometrial carcinoma. MRI allows to choose type of surgery: laparoscopy or laparotomy and define volume of radiotherapy.