The ongoing structuring of human papillomavirus (HPV) vaccination in middle schools in Nouvelle-Aquitaine, France.

CONTEXT: As is the case throughout France, vaccination coverage against human papillomavirus (HPV) infections in the Nouvelle-Aquitaine region is too low to limit viral circulation and to have an impact on the incidence of virus-induced pathologies. INTERVENTION METHODOLOGY: The Nouvelle-Aquitaine Regional Health Agency (ARS) has decided to set up a large-scale vaccination action in the 7th-grade classes of all 643 Nouvelle-Aquitaine middle schools during the 2023-2024 school year. This public health intervention targeting 11-to-13-year-olds shall bring together national education, health Insurance, the regional center for pharmaco-vigilance, and private health professionals. A call for applications (January 2023) led to the recruitment of vaccination centers tasked with the deployment of mobile teams. A tool for dematerialization of parental authorization was devised. A communication agency was recruited (March 2023) to set up targeted social marketing actions and increase the rate of adherence. EXPECTED RESULTS: Close to 25% of parents are likely to respond favorably to the vaccination offer. The project should help not only to increase vaccination coverage of adolescents through intervention in middle schools, but also have an impact on the demand for vaccination among city-based healthcare professionals. CONCLUSION: Increased vaccination coverage should ultimately reduce the incidence of HPV-induced pathologies. A catch-up campaign could be carried out in high schools from the 2027/2028 school year.

[Medico-economic evaluation of the impact of measures to adapt to the switch to surgery robot-assisted in urology]. / Évaluation médico-economique de l'impact de mesures d'adaptation au virage de la chirurgie robot-assistée en urologie.

INTRODUCTION: The development of robot-assisted urological surgery is held back by the lack of robust medico-economic analyses and their heterogeneity. We conducted a medico-economic study to evaluate the implementation of measures to optimize the transition to robotic surgery. METHOD: We carried out a single-center, controlled study from the point of view of the public healthcare establishment for 4 years. Economic data collection was based on a micro-costing method and revenues from stay-related groups. Clinical data corresponded to mean lengths of stay, operating duration, complications and stays in intensive care. The measures to optimize the transition to robotic, implemented mid-study period, enabled before/after comparison. RESULTS: Altogether, 668 patients undergoing robotic surgery were included. Robotic activity increased significantly from periods 1 to 2 to 256% (P=<0.001) as did the overall proportion of robotic by 45% to 85% (P=<0.001). The mean lengths of stay fell significantly, 6.8 d vs. 5.1 d (P<0.001). Costs and revenues increased significantly, resulting in a persistent deficit for the activity €226K vs. €382K (P=<0.001). With increased volume of activity, the deficit per operation and the cost per minute of robotic operating room fell significantly, €3,284 vs. €1,474/procedure (P=<0.001) and €27 vs €24/min (P=<0.029), tending towards a break-even point (=zero deficit) at 430 operations per year. CONCLUSIONS: Robotic-assisted surgery can be significantly optimized by implementing measures for the robotic turn to reach a break-even point at 430 operations per year. A better multidisciplinary case mix could lower the break-even volume of activity in short term. LEVEL OF EVIDENCE: 3.

[Obstetrics complications of systemic lupus erythematosus and antiphospholipid syndrome: A multidisciplinary management]. / Complications obstétricales du lupus érythémateux systémique et du SAPL : une prise en charge multidisciplinaire.

The main autoimmune diseases responsible for obstetric complications are systemic lupus erythematosus and antiphospholipid syndrome. They are particularly associated with an increased risk of miscarriage, stillbirth, intrauterine growth restriction, prematurity and pre-eclampsia. Therapeutics to prevent its complications are mainly low dose aspirin and low molecular weight heparins. However, the introduction of these therapies will have to consider the benefit/risk ratio to manage pregnancy and especially delivery. Consistency of care provided by autoimmunity specialists and gynaecologist-obstetricians is extremely important and must be promoted through regular exchanges, fuelled by a mutual culture, through multidisciplinary consultation meetings.

[Retrospective study of the impact of training on the management of immediate post-partum hemorrhage]. / Impact d'une formation sur la prise en charge de l'hémorragie du post-partum.

OBJECTIVE: The aim of the study was to assess the impact of the introduction of training workshops on the quality of prevention and management of Post-Partum Hemorrhage (PPH) in a type III university center. METHODS: A clinical audit was carried out in our type III university center before and after the introduction of training workshops on the prevention and management of PPH, in two periods between January 1st to December 31st 2011 and March 1st and August 1st, 2015. Training workshops were according to the recommendations for clinical practice of the National College of Gynecologists-Obstetricians French published in 2014, and included a theoretical portion and a simulation of low fidelity manikin. Data on the management of patients presenting with PPH after vaginal birth of a singleton were retrospectively collected consecutively from medical records. Data were collected using a standardized analytical grid. Between the two data collections, some improvement actions were implemented. RESULTS: After implementation of training workshops, the proportion of patients with active management of the third stage of labor (prophylactic uterotonic after delivery) has significantly improved (72% before, vs. 92% after, P=0.001); time to PPH diagnosis has been significantly higher notified (40% before, vs. 94% after, P<0.001), as well as the quantification of bleeding at diagnosis (46% before, vs. 72% after, P<0.003) and total bleeding (68% before, vs. 92%, P<0.001). PPH-specific monitoring sheet was found to be used significantly more frequently (3 before, vs. 30 after, P=0.00015). Additionally, the Physician Anesthesiologist has been contacted significantly more often (34% before, vs. 53% after, P=0.002). CONCLUSION: Our study highlights a significant improvement in professional practices between 2011 and 2015 on PPH prevention and management in our type III university center.

[Human Resources for Unplanned Activities in Obstetrics and Gynecology. Consensus statements by the CNGOF, CARO, CNSF, FFRSP, SFAR, SFMP and SFN]. / Ressources humaines pour les activités non programmées en gynécologie-obstétrique. Propositions élaborées par le CNGOF, le CARO, le CNSF, la FFRSP, la SFAR, la SFMP et la SFN.

OBJECTIVE: To determine a minimum threshold of human resources (midwives, obstetricians and gynecologists, anesthesiology and intensive care units, pediatricians) to ensure the safety and quality of unplanned activities in Obstetrics and Gynecology. MATERIALS AND METHODS: Consultation of the MedLine database, the Cochrane Library and the recommendations of authorities. Meetings of representative members in different modes of practice (university, hospital, liberal) under the aegis of and belonging to the French College of Obstetricians and Gynecologists (CNGOF), the French Society of Anesthesia and Resuscitation (SFAR), the French Society of Neonatalogy (SFN), the French Society of Perinatal Medicine (SFMP), the French College of Midwives (CNSF), the French Federation of Perinatal Care Networks (FFRSP) with elaboration of a re-read text by external experts, in particular by the members of the Boards of Directors of these authorities and of Club of Anesthesiology-Intensive Care Medicine in Obstetrics (CARO). RESULTS: Different minimum thresholds for each category of caregivers were proposed based on the number of births/year. These proposed minimum thresholds can be modulated upwards according to the types (level I, IIA, IIB or III) or the activity (existence of an emergency reception service, maternal-fetal and/or surgical activity of resort or referral). Due to peak activity and the possibility of unpredictable concomitance of urgent medical procedures, it is necessary that organizations plan to use resource persons. The occupancy rate of the target beds of a maternity ward must be 85%. CONCLUSION: These proposed minimum thresholds are intended to help caregivers providing non-scheduled perinatal as well as Obstetrics and Gynecology care to make the most of the human resources allocated to institutional bodies to ensure their safety and quality.