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BACKGROUND: Objective Structured Clinical Examinations (OSCEs) aim to assess medical students' clinical skills rather than just their theoretical knowledge. We propose a study between the learning style of second-cycle medical students and their performance in OSCEs. METHODS: During their internship at our hospital, students were invited to complete the LSQ-Fa, a questionnaire designed to identify their preferences among 4 learning styles: active, reflective, theoretical, and pragmatic. In parallel, an evaluation of their clinical skills was conducted through OSCEs. We then performed an analysis to establish a correlation between learning styles and OSCE performance, to better understand how learning preferences influence academic outcomes. RESULTS: Between April 2021 and January 2023, 55 students were evaluated by OSCEs and had completed the LSQ-Fa. The average OSCE score was 14.8/20. The theoretical learning style was predominant in 47.3% of students, followed by active (27.3%), reflective (14.6%), and pragmatic (5.4%), with 3 cases of mixed active and theoretical styles (5.4%). No significant correlation was observed between learning style and OSCE performance (p = 0.28), although students with a pragmatic style recorded a slightly higher average. CONCLUSION: This study highlights the importance of considering diverse learning styles in the design of medical education programs.
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Competência Clínica , Avaliação Educacional , Aprendizagem , Estudantes de Medicina , Humanos , Competência Clínica/normas , Avaliação Educacional/métodos , Estudantes de Medicina/psicologia , Feminino , Masculino , Educação de Graduação em Medicina , Inquéritos e QuestionáriosRESUMO
Background: Hidradenitis suppurativa (HS) is a chronic and inflammatory disease. Its management depends on the stage and extent of the disease. Surgery plays an important role in treatment options. This study explores the factors influencing healing after wide excision. Methods: This study analyzed data from patients who underwent wide excision for HS between 2016 and 2021. Results: A total of 160 patients (64.4% women) were included, with surgeries performed in the axillae (70), inguinal-ano-genital (73), and other locations (17, including gluteal). The mean TTWC was 74 ± 6 days, varying from 11 to 445 days. Factors negatively influencing TTWC included axillary localization (p < 0.001) and the presence of another inflammatory disease (p = 0.017). Factors positively influencing healing were smoking (<0.001) and previous or ongoing medical treatment (antibiotherapy or biologics) (p = 0.011). Obesity or being overweight did not impact the TTWC in multivariate analysis, although overweight was significant in univariate analysis. Conclusions: While smoking cessation remains important in the management of HS, it does not appear to be a prerequisite for successful surgical treatment. Conversely, patients with an inflammatory disease or those undergoing surgery for an axillary lesion exhibit slower healing and should be informed of potential healing delays before surgery.
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BACKGROUND: Hyperthermic intraperitoneal chemotherapy (HIPEC) associated with CC0 excision is performed using either an open (OPEN_HIPEC) or closed abdominal technique (CLOSED_HIPEC). However, little data is available on the costs of this treatment, as there is no code for HIPEC in the French Classification of Medical Acts. Oncological outcomes and the mean cost of hospitalization were compared. METHODS: Between 2017 and 2021, 144 patients with peritoneal carcinomatosis (all etiologies) were included (OPEN_HIPEC, n = 70; CLOSED_HIPEC, n = 74) in this retrospective two-center study. Morbi-mortality, overall survival (OS), recurrence-free-survival (RFS) and mean cost of hospitalization were compared. RESULTS: The median OS and RFS were 71.3 months [63-71.5] and 26.8 months [20-35.3] respectively, and were similar for both techniques; and after stratification by histology. Multivariate analysis adjusted on PCI score of OS identified mitomycin as a protective factor (HR = 0.31 [0.10-0.90], p = 0.032) and ASA score>2 (HR = 2.32 [1.32- 4.06], p = 0.003) and number of resection (HR = 1.21 [1.06-1.39], p = 0.006) as a risk factors of RFS. Complication rates at day 30 were similar between OPEN and CLOSED_HIPEC, 31 (44.3 %) vs 42 (56.8 %); p = 0.135. OPEN_HIPEC had more severe complications (11 (35.5 %) vs 6 (14.3 %); p = 0.034). The mean cost of hospitalization was estimated as 15,627 for OPEN_HIPEC and 14,211 for CLOSED_HIPEC for a mean length-of-stay of 12.7 and 16.7 days respectively. The mean amount received by the hospital per hospitalization was estimated at 16,399 and 15,536 respectively. CONCLUSIONS: OS and RFS were similar for open and closed HIPEC. Severe complications at day 30 were more frequent in OPEN_HIPEC group. The amount received by hospital for both HIPEC techniques is sufficient.
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Hipertermia Induzida , Intervenção Coronária Percutânea , Humanos , Quimioterapia Intraperitoneal Hipertérmica , Terapia Combinada , Estudos Retrospectivos , Hipertermia Induzida/métodos , Abdome , Hospitalização , Procedimentos Cirúrgicos de Citorredução/métodos , Taxa de Sobrevida , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
Objectives: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) gives encouraging results in the treatment of peritoneal metastasis (PM). The current recommendations require at least 3 sessions of PIPAC. However, some patients do not complete the full treatment course and stop after only 1 or 2 procedures, hence the limited benefit. A literature review was performed, with search terms including "PIPAC" and "pressurised intraperitoneal aerosol chemotherapy." Content: Only articles describing the causes for premature termination of the PIPAC treatment were analysed. The systematic search identified 26 published clinical articles related to PIPAC and reporting causes for stopping PIPAC. Summary: The series range from 11 to 144 patients, with a total of 1352 patients treated with PIPAC for various tumours. A total of 3088 PIPAC treatments were performed. The median number of PIPAC treatments per patient was 2.1, the median PCI score at the time of the first PIPAC was 19 and the number of patients who did not complete the recommended 3 sessions of PIPAC was 714 (52.8%). Disease progression was the main reason for early termination of the PIPAC treatment (49.1%). The other causes were death, patients' wishes, adverse events, conversion to curative cytoreductive surgery and other medical reasons (embolism, pulmonary infection, etc ). Outlook: Further investigations are necessary to better understand the causes for interrupting PIPAC treatment and also improving the selection of patients who are most likely to benefit from PIPAC.
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Otherwise known as Verneuil's disease, hidradenitis suppurative (HS) is a severe dermatosis of heterogeneous appearance affecting 1% of the population. Its pathophysiology is multifactorial, involving genetic predisposition, inflammatory disorder and environmental elements. Its diagnosis is based on the association of three clinical characteristics: characteristic lesions, typical localizations, and the chronic and recurrent nature of the lesions. Given its diversified aspects, diagnosis can be difficult to achieve. As its manifestations often include abscesses, it is important for the surgeon to know how to detect this pathology. The development of biologics has improved treatment of this disease, treatment that necessitates a multidisciplinary medical and surgical approach involving dermatologists and proctologists as well as surgeons. The objective of this report is to synthesize what a surgeon will need to know so as effectively treat HS patients.
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Hidradenite Supurativa , Cirurgiões , Humanos , Hidradenite Supurativa/diagnóstico , Hidradenite Supurativa/cirurgia , Abscesso/diagnóstico , Abscesso/etiologia , Abscesso/cirurgiaRESUMO
INTRODUCTION: Onboard surface ships like destroyers and frigates, there is ROLE 1, whereas on a three-landing helicopter deck (LHD) and aircraft carrier, there is ROLE 2, with a surgical team. At sea, evacuation takes more time than on any other theater of operation. It also costs more money, so we wanted to analyze how many patients have been maintained onboard, thanks to ROLE 2. Moreover, we wanted to analyze the surgical activities on the LHD MISTRAL ROLE 2. METHODS: We performed a retrospective observational study. We retrospectively analyzed all surgery cases performed on the MISTRAL between January 1, 2011, and June 30, 2022. During this period, there were only 21 months with a surgical team ROLE 2 onboard. We included all consecutive patients who underwent minor or major surgery onboard. RESULTS: A total of 57 procedures were performed during the period, involving 54 patients (52 males and 2 females) with an average age of 24.4 ± 1.9 years. The most frequent pathology was abscess (pilonidal sinus abscess, axillary abscess, or perineal abscess) (n = 32; 59.2%). Only two Medical Evacuations were conducted because of surgery; the other patients who underwent surgery were maintained onboard. CONCLUSIONS: We have shown that using ROLE 2 aboard the LHD MISTRAL decreases the use of Medical Evacuation. It also helps to perform surgery under better conditions for our sailors. Doing everything to keep sailors onboard seems to be an important point.
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Abscesso , Militares , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Abscesso/cirurgia , Estudos Retrospectivos , Navios , AeronavesRESUMO
To improve the prognosis and maintain quality of life in patients with peritoneal metastasis (PM), a novel treatment has been introduced-pressurized intraperitoneal aerosol chemotherapy (PIPAC). The majority of teams propose at least 3 PIPAC procedures. However, for many patients PIPAC is stopped after only one or two procedures. The aim of this study was to identify the reasons for stopping PIPAC after only one or two procedures and to establish a profile of poor candidates. This retrospective, multicenter cohort study included all patients who underwent PIPAC in three French expert centers between 2015 and 2021. A total of 268 PIPAC procedures were performed in 89 patients. Of them, 48.3% of patients underwent fewer than three procedures: 28.1% had one, 20.2% two and 51.7% three or more PIPAC procedures. The main reason for stopping PIPAC, regardless of the number of procedures, was disease progression, in 55.8% of cases. Other reasons for stopping PIPAC were non-access to the abdominal cavity (7.9%), conversion to cytoreductive surgery (13.5%), post-PIPAC adverse events (7.9%), patients' wishes (10.1%) and death (2.2%). In univariate analysis, patients who received fewer than three PIPACs less frequently had chemotherapy beforehand (91% vs 100%, p = 0.05), less frequently had bimodal treatment (70% vs 87%, p = 0.04), had more ascites (median 80 ml vs 50 ml, p = 0.05) and more frequently had carcinomatosic ascites (48.8% vs 23.9%, p < 0.01). Performing PIPAC alone in chemotherapy-naïve patients with ascites should be avoided.
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Aerossóis , Ascite , Neoplasias Peritoneais , Humanos , Aerossóis/efeitos adversos , Ascite/etiologia , Estudos de Coortes , Seleção de Pacientes , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/secundário , Qualidade de Vida , Estudos RetrospectivosRESUMO
OBJECTIVES: Regarding war surgery (WS), the initial and continuing education of French military gastrointestinal surgeons (FMGIS) is considered flawed and inappropriate. This results from the low incidence of gastrointestinal (GI) trauma, its predominantly non-surgical management, and a daily surgical practice that strongly differs from WS. Conversely, cytoreductive surgery (CRS) of peritoneal metastases has similarities with WS which led us to assess its potential contribution to the initial and continuing education of FMGIS in WS. METHODS: We reported the activities of the GI surgery departments of the military teaching hospitals of Percy and Begin. The first one dedicated to traumatology and the second to CRS. We then specifically looked into the surgical procedures conducted by the FMGIS during deployment from January 2004 to December 2014. RESULTS: Amongst the 600 severe trauma patients admitted to the Percy trauma center between January 2019 and December 2020, 17 underwent abdominal surgery with a total of 25 procedures performed. During the same period, 61 patients undertook CRS in Begin with an average of 7 surgical processes per patient carried out and a total of 418 abdominal surgical procedures. Outside abdominal packing and nephrectomy (not performed in CRS), the numbers of splenectomy, gastrointestinal / gynecological resections (hysterectomy and/or adnexectomy), or liver resection were higher during CRS compared to abdominal trauma surgery with 10 times less patients (10 vs 1, 43 vs 9, 20 vs 0, 6 vs 0, respectively). CONCLUSION: CRS, through its similarities with WS, seemed to be an appropriate tool for the initial and continuing education of FMGIS in WS and, to an extent, of civilian trauma surgeons who could eventually treat terrorist attacks casualties on the national territory.
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Cirurgiões , Traumatologia , Feminino , Humanos , Procedimentos Cirúrgicos de Citorredução , Traumatologia/educação , Centros de Traumatologia , Hospitalização , Estudos RetrospectivosRESUMO
INTRODUCTION: Pressurized Intraperitoneal Aerosol chemotherapy (PIPAC) is a new surgical technique for the treatment of unresectable peritoneal carcinomatosis. Very little data is available on the costs of this treatment in France as there is currently no code for PIPAC in the French Common Classification of Medical Acts (CCAM). Our objective was to estimate the mean cost of hospitalization for PIPAC in two French public teaching hospitals. METHODS: The mean cost of hospitalization was estimated from the mean fixed-rate remuneration paid to the hospital and the mean additional costs of treatment paid by the hospital. At discharge a patient's hospitalization is classified into a diagnosis related group, which determines the fixed-rate remuneration paid to the hospital (obtained from the national hospitals database - PMSI). Costs of medical devices and drug treatments specific to PIPAC, not covered by the fixed-rate remuneration, were obtained from the hospital pharmacies. RESULTS: Between July 2016 and November 2021, 205 PIPAC procedures were performed on 79 patients (mean procedures per patient = 2.6). Mean operating room occupancy was 165 min. The mean fixed-rate remuneration received by the hospitals per PIPAC hospitalization was 4031. The actual mean cost per hospitalization was 6562 for a mean length-of-stay of 3.3 days. Thus, each PIPAC hospitalization cost the hospital 2531 on average. CONCLUSION: The current reimbursement of PIPAC treatment by the national health system is insufficient and represents only 61% of the real cost. The creation of a new fixed-rate remuneration for PIPAC taking into account this cost differential is necessary.
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Hospitalização , Neoplasias Peritoneais , Humanos , Aerossóis , Hospitalização/economia , Neoplasias Peritoneais/tratamento farmacológico , Custos e Análise de Custo , Hospitais Públicos/economia , Hospitais de Ensino/economia , FrançaRESUMO
Objectives: Oxaliplatin immune-induced syndrome (OIIS) was recently recognized as an uncommon complication of oxaliplatin therapy. Methods: We report an exceptionally OIIS after pressurized intraperitoneal aerosol chemotherapy (PIPAC). Results: Our patient developed a severe OIIS probably related to the intraperitoneal administration of oxaliplatin. Specific tests were performed and detected high-titer antibodies to oxaliplatin. Conclusions: The OIIS is a rare. Physicians had to be aware of that clinical situation because it could be reversible, even in case of peritoneal advanced disease, and ICU treatment is justified.