Impact of therapeutic education on the evolution of social representations of medication in patients with Parkinson's disease: A quantitative and qualitative study (ETPARK REMED).

BACKGROUND: Among the workshops of our therapeutic patient education (TPE) program, the medication workshop (TPEM workshop) is very frequently proposed to patients in view of the difficulties they encounter related to the complexity of managing antiparkinsonian treatment. Patients' appropriation of their medications could depend on their social representations. OBJECTIVES: To evaluate the effect of our TPEM workshop on the social representations PD patients have of their medications and to compare it with that of another therapeutic intervention such as a talking group defined as the control group. METHODS: This single-center, prospective, randomized, parallel-group study investigated the social representations of medication through a questionnaire on knowledge about antiparkinsonian medications, a questionnaire on beliefs about medication (BMQ), and a word association task. RESULTS: In the TPEM group (n=16), the workshop induced significant effects over time on the knowledge questionnaire (P=0.01), BMQ specific necessity and concerns scores (P=0.04 and 0.01, respectively), necessity-concerns differential (P=0.04), and BMQ general harm (P=0.04). No significant difference was found in the talking group (n=6). Comparison of the two groups showed a significant difference of the BMQ general harm with a decrease in belief in the harmfulness of the medications in the workshop group (P=0.03). The results of the verbal association task showed a modification in the content and structure of the social representations of medication in the TPEM group. DISCUSSION: The TPEM workshop helped reduce initial negative aspects of medication representations. Improved knowledge of their medication allowed patients to feel more competent and legitimate in communicating with caregivers, modifying their beliefs about medications. Indeed, the medication was perceived as less restrictive, care becoming central as shown by the emergence of the medical team in the social representations of the medication. CONCLUSION: All the results show a specific beneficial effect of the TPEM workshop through an evolution of the social representations of medications, which became more positive in our PD patients.

Study of childbirth education classes and evaluation of their effectiveness.

BACKGROUND: Childbirth education classes are antenatal support services offered to pregnant women or to the couple, aimed at increasing their knowledge regarding pregnancy, labour, delivery, breastfeeding, parenthood and newborn care. OBJECTIVE: The aim was to evaluate the effectiveness of Birthing Classes through the analysis of the occurrence of C-section, epidural analgesia, behavior during labor and delivery of the women who participated to the course as compared to those who did not attend it. Moreover, the level of satisfaction of pregnant women who attended the course was measured with a questionnaire of 20 items handed out after the delivery. METHODS: To measure the satisfaction level of pregnant women, in the period from February 2017 to October 2017, a questionnaire of 20 items was used. In order to analyze the results of the births the medical records were consulted. RESULTS: In the period of time going from February 2017 to October 2017 there were 147 women who have delivered and who have filled in the questionnaire. According to the multivariable analysis, there were no differences in the frequency of C-sections between the two groups (OR=0.8, 95%CI=0.3-1.7, p=0.503), whereas the frequency of epidural analgesia was lower in women who attended the Birthing Class (OR=0.3, 95%CI=0.1-0.9, p=0.036). We also observed that women who attended the Birthing Class: 1) had a higher likelihood of using breathing techniques during the labor (OR=5.5, 95%CI=1.5-20.0, p=0.009); 2) had a higher likelihood of taking advantage of the visualization exercises during the labor (OR=2.5, 95%CI=1.1-6.0, p=0.039). There was no other relevant difference between the two groups. DISCUSSION: The benefits of perinatal education are difficult to evaluate systematically, and further research would be required to determine real effects and agree upon reliable indicators of effectiveness. CONCLUSIONS: This study identified several positive factors that confirm the results of other studies indicating that antenatal classes are effective for women giving birth for the first time/nulliparous women, based on an analysis of childbirth outcomes, in order to improve maternal and neonatal health.

Achievements of the Belgian Antibiotic Policy Coordination Committee (BAPCOC).

A Belgian Antibiotic Policy Coordination Committee (BAPCOC) was officially established in 1999 by Royal Decree. The overall objective of BAPCOC is to promote judicious use of antibiotics in humans and animals and to promote infection control and hospital hygiene, with the overall aim to reduce antibiotic resistance. BAPCOC fostered strong and interdisciplinary public health, scientific and political leadership, which led to many evidence-based interventions such as multimedia campaigns to promote the prudent use of antibiotics in the community, national campaigns to promote hand hygiene in hospitals, publication of clinical practice guidelines, staffing and technical support for establishment of antibiotic management teams in all Belgian hospitals, surveillance programmes on antibiotic use and resistance in humans and animals and the promotion of research. These activities and interventions resulted in a measurable decrease in antibiotic use and resistance in the community and hospitals.

Distal tibial and fibular epiphyseal fractures in children: prognostic criteria and long-term results in 158 patients.

From 1974 to 1993, 158 injuries of the ankle joint were treated at the Department of Orthopedics and Traumatology of Santobono Children's Hospital. One hundred thirty-two patients were treated conservatively; 26 patients underwent surgical treatment. Fibular fractures of the malleolus without epiphyseal separation or dislocation (68 patients) were excluded from this review. Of the 158 patients, 113 (70%) were available for follow-up. The mean age of patients was 11 years. The mean follow-up was 6 years (range 3-15 years). In this review, the authors compare, based on the degree of epiphyseal separation or dislocation, the Carothers-Crenshaw classification, which is based on the mechanism of trauma, with the Salter-Harris classification, which is based on anatomical-radiographic criteria. The aim is to review the authors' patients based on these classifications, to verify the prognostic ability of these criteria and thus to establish a better and more viable treatment for these injuries. Therefore, two fundamental factors should be considered for the prognosis: the mechanism of trauma and damage to the epiphyseal plate. Compressive trauma and adduction-supination trauma are the most dangerous types of injury, and any damage or gap in the physis should be perfectly reduced, by open means if necessary, to prevent a bone bridge from forming.

The use of external fixators in femur fractures in children.

Between 1988 and 1993, 81 children with 82 femur fractures were treated with external fixators at the Santobono Children's Hospital of Naples. This technique was reserved for children older than 6 years with open fractures, multiple fractures, multiple trauma, and unstable fractures. The patients were placed in skin traction on admission, and after 24-48 h, the external fixator was applied under general anesthesia. Therefore, within 1 week the children were able to take care of themselves and to attend school. The fixator was very well tolerated and was removed 8-9 weeks later. The fractures healed with good alignment, no complications with few cases of superficial infections, and less overgrowth. The use of external fixation is recommended for its simplicity and lack of complications.

Is gentle manipulative reduction and percutaneous fixation with a single screw the best management of acute and acute-on-chronic slipped capital femoral epiphysis? A report of 70 patients.

We report the results of the management of acute and acute-on-chronic slipped capital femoral epiphysis (SCFE) for 70 patients (81 hips) with an average follow-up of 6 years (range 1-15 years). We clinically reviewed 51 patients (55 hips) with acute or acute-on-chronic slip treated in our department from 1978 to 1993 with clinical and radiographic examination. Of these, 10 patients (11 hips) underwent a three-dimensional computed tomography (CT) scan to provide more details of the remodeling process. Percutaneous pinning with one cannulated screw appears to offer significant advantages. It is stable, safe, and reliable; there is no blood loss; the scar is small; hospital stay is brief; and early weightbearing is possible 2 weeks after the procedure, with low incidence of complications. Last, but not least, children can soon return to school. We conclude that preoperative reduction with very gentle manipulation and percutaneous pinning with a single screw is the best treatment for SCFE.

Infantile type of Blount's disease: considerations concerning etiopathogenesis and treatment.

The proper treatment of the infantile type of Blount's disease is still a controversial issue. We postulate the hypothesis of the etiopathogenesis of the infantile type of Blount's disease as a disease related to a dysplastic linkage between epiphysis and metaphysis. Therefore, considering the radiographic observations of a 26-month-old girl admitted in our department in 1986 with the infantile type of Blount's disease (type II Langenskiold--tibial femoral angle 24 degrees), the consequential optimal management of this condition is the need to apply a treatment consisting of the epiphyseal distraction capable of interrupting this dysplastic linkage, avoiding recurrences and damage to the growth cartilage. This child was treated with early, slow, and monocompartmental distraction by Ilizarov apparatus for 11 weeks. When the Ilizarov apparatus was removed, full recovery was achieved, the leg was clinically straight, and the mechanical axis was restored. The long-term follow-up (7 years) confirms this operation as a definitive treatment. It was less traumatic for the child, without recurrences or disorders of growth cartilage, supporting the dysplastic origin of infantile type of Blount's disease and the efficacy of this type of treatment.