Completion pancreatectomy during pancreatoduodenectomy: A lifesaving solution in high-risk patients.

BACKGROUND: Postoperative pancreatic fistula (POPF) is responsible of most major complications and fatalities after PD. By avoiding POPF, TP may improve operative outcomes in high-risk patients. The aim was to compare total pancreatectomy (TP) and pancreatoduodenectomy (PD) in high-risk patients and evaluate results of implementing a risk-tailored strategy in clinical practice. METHODS: Between 2014 and 2023, 139 patients (76 men, median age 67 years) underwent resection of disease located in the head of the pancreas. Starting January 1, 2022, we offered TP to patients at high POPF risks (fistula risk score (FRS) ≥7) and to patients with intermediate POPF risks (FRS: 3-6) and high risks of failure to rescue (age> 75 years, ASA score ≥3). We compared outcomes of TP and PD and evaluated the results of the new strategy implementation on operative outcomes. Propensity score-based analysis was performed to limit bias of between-group comparison. RESULTS: Eventually, 26 (19%) patients underwent TP and 113 (81%) patients underwent PD. Severe complications occurred in 42 (30%) patients and 13 (9%) patients died. TP resulted in shorter lengths of hospital stay (median: 14 days [11; 18] vs. 17 days [13; 24], p = 0.016) and less risks of post-pancreatectomy hemorrhage (PPH) (0% vs. 20%, p < 0.001) compared to PD. Crude and propensity match analysis showed that the implementation of a risk-tailored strategy led to significant reduction of reoperation, POPF, PPH and mortality rates. CONCLUSION: The use of TP as part of a risk-tailored strategy in high-risk patients can be lifesaving.

Effects of a healthcare students' prevention intervention for school children on their own substance use: a before-after study.

BACKGROUND: Cognitive dissonance theory and research has suggested that engaging in prevention interventions for other students may be a means of reducing one's own problematic behaviors in order to reduce potential cognitive dissonance. This study assessed the effects of a new mandatory prevention intervention program for healthcare students in France. The aim was to measure the effects of engaging in a prevention program in schools on the usual increase in substance use in student populations. METHODS: Healthcare students were trained in a French university to develop psychosocial competences as a health promotion means (FEPS training) or more specifically to prevent substance use in teenagers (Unplugged program training). The students (n = 314) who accepted to take part in the study from both groups completed questionnaires before their interventions in schools, and at the end of the year, measuring their representations and behaviors regarding psychoactive substances. RESULTS: The results indicated a significant reduction in alcohol consumption in terms of quantity, but no significant reduction in tobacco and marijuana consumption. CONCLUSIONS: This study showed that, contrary to the usual increase in substance use in students as they advance in their year, the students who took part in this study showed reduced self-reported consumption of alcohol after they had performed the prevention intervention in schools regardless of the type of training they had received (general health promotion vs. specific substance use prevention program). Limitations and future perspectives are discussed.

Evaluation of a French health action-training program by its stakeholders; healthcare students and host institution.

BACKGROUND: Mandatory "sanitary service" is an inter-disciplinary health promotion program that ensures inclusion of action training in the curriculum of French students in healthcare professions. Its evaluation is important to identify areas for improvement. OBJECTIVES: The objective was to evaluate the satisfaction of the actors with the general perception of the program and with its three different phases: e-learning, practical training, and interventions. DESIGN: Retrospective, single-center study based on two self-report questionnaires completed by students and host institutions in 2021-2022. PARTICIPANTS: Students in healthcare (medicine, pharmacy, odontology, midwifery, physical therapy and nursing) from a French university. METHODS: We calculated and compared scores based on closed-ended questions exploring several dimensions of the program (general perception of the sanitary service, and its three phases). RESULTS: Among the 732 students surveyed, 418 were included (57.1 %), while among 99 host institutions surveyed (including 86 schools), 77 were included (77.8 %). The overall sanitary service student satisfaction score was 3.26 / 5 (SD = 0.96). Interventions were the best scored of the three phases of the program (3.92 / 5 (SD = 0.87)). E-learning and practical training scores varied significantly according to students' training courses (p < 0.001). Students who intervened in elementary schools (n = 253) most appreciated the interventions (4.11 / 5 (SD = 0.84)). In free comments, students emphasized that interdisciplinarity was appreciated even if it made organization more complex. The overall host institution score was 3.73 / 4 (SD = 0.25). All the heads of institutions expressed their wish to resume the sanitary service the following year. CONCLUSIONS: The actors of the sanitary service validated the interest, quality, organization, and feasibility of an inter-field training program in health prevention for healthcare students.

Healthcare students' prevention training in a sanitary service: analysis of health education interventions in schools of the Grenoble academy.

BACKGROUND: The sanitary service is a mandatory prevention training programme for all French healthcare students. Students receive training and then have to design and carry out a prevention intervention with various populations. The aim of this study was to analyse the type of health education interventions carried out in schools by healthcare students from one university in order to describe the topics covered and the methods used. METHOD: The 2021-2022 sanitary service of University Grenoble Alpes involved students in maieutic, medicine, nursing, pharmacy and physiotherapy. The study focused on students who intervened in school contexts. The intervention reports written by the students were read doubly by independent evaluators. Information of interest was collected in a standardised form. RESULTS: Out of the 752 students involved in the prevention training program, 616 (82%) were assigned to 86 schools, mostly primary schools (58%), and wrote 123 reports on their interventions. Each school hosted a median of 6 students from 3 different fields of study. The interventions involved 6853 pupils aged between 3 and 18 years. The students delivered a median of 5 health prevention sessions to each pupil group and spent a median of 25 h (IQR: 19-32) working on the intervention. The themes most frequently addressed were screen use (48%), nutrition (36%), sleep (25%), harassment (20%) and personal hygiene (15%). All students used interactive teaching methods such as workshops, group games or debates that was addressed to pupils' psychosocial (mainly cognitive and social) competences. The themes and tools used differed according to the pupils' grade levels. CONCLUSION: This study showed the feasibility of conducting health education and prevention activities in schools by healthcare students from five professional fields who had received appropriate training. The students were involved and creative, and they were focused on developing pupils' psychosocial competences.

Validity and reliability of standardized instruments measuring physician communication and interpersonal skills in video-recorded medical consultations - A systematic review.

OBJECTIVE: To identify standardized instruments measuring physician communication and interpersonal skills based on video-recorded consultations. METHODS: We searched electronic databases for primary studies published from 1950 to 2022. Eligible studies had to report the validation of standardized instruments dedicated to the assessment of physician interpersonal skills based on video-recorded consultations with adult patients. RESULTS: Of 7155 studies retrieved, 13 primary studies involving nine standardized instruments were included. The median number of physicians and participants was 23 (range, 1-200) and 71 (range, 1-950), respectively. Seven out of nine instruments were multidimensional and comprised a median number of 23 items (range, 7-95). The conceptual framework was reported for two instruments only. Content analysis identified 12 key behaviors with substantial overlap across instruments. The Four Habits Coding Scheme (4-HCS) yielded satisfactory validity and reliability while the evidence on psychometric properties was limited for other instruments. CONCLUSION: Limited evidence supports the psychometric attributes for most of the published standardized instruments dedicated to assessing physician communication and interpersonal skills. PRACTICE IMPLICATIONS: Although the decision to use a specific instrument depends on the study aims, the 4-HCS appears to be the most reliable instrument for assessing physician communication and interpersonal skills based on video-recorded consultations.