[Specialized Studies Diploma (S.S.D): assessment of Urology and Andrology by degree candidates at Faculté des Sciences de la Santé (FSS) at Cotonou]. / Diplome d'Etudes Specialisees (D.E.S) d'Urologie- Andrologie: appreciation de la formation par les candidats au dit diplome a la Faculte des Sciences de la Sante de Cotonou.

PURPOSE: Inventory views of urologists in training on teaching of Urology and Andrology received at Cotonou. METHODS: An anonymous electronic questionnaire was sent by email to 26 doctors in training of specialized studies diploma of Urology and Andrology current month of May and June 2013. The questionnaire asked their knowledge of educational objectives, their appreciation of theoretical courses and practical training Receipts. RESULTS: 16 responses were obtained. The average age of physicians in SSD was 33.9 years± 6.14 (26 years-47 years). The sex ratio was 15 males to 1 female. The training was funded on equity by 25% of doctors. Residents had an understanding of the objectives of their training in urology and andrology: 68.7% knew the objectives of theoretical courses, 87.5% participated in organized lectures, 62.5% knew practical purposes, 93.7% knew the terms of the evaluation at the end of the year. The primary source of documentation was digital document (CD, DVD, computer, websites) 43.7%. In the weekly schedule, 75% of residents assisted consultations carried out by a senior, 93.8% attended a staff operative programming. Over a month, the frequency of assistance in the operating room as first aid procedure had a median of 4 (1 -10). One in 15 received regular debriefing following the completion of care act. The duration of hospital daily work was between 4 and 8 hours for 68.9% of the residents. CONCLUSION: Opinion of doctors in training on urological acquisitions highlights the need to support the development of specialized studies diploma inUrology and Andrology at Faculty of health sciences at Cotonou.

OBJECTIFS: Recenser l'opinion des urologues en formation sur l'enseignement d'urologie et d'andrologie reçu à Cotonou. PATIENTS ET MÉTHODES: Un questionnaire électronique anonyme a été adressé aux 26 médecins en formation du DES d'urologie andrologie courant mai et juin 2013. Le questionnaire recueillait leur connaissance des objectifs pédagogiques, leur appréciation des cours théoriques reçus et des stages pratiques. RÉSULTATS: 16 réponses ont été obtenues. La moyenne d'âge des médecins en DES était de 33,9ans± 6,14 (26ans-47ans). Le sexe ratio était de 15 hommes pour 1 femme. La formation était financée sur fonds propres par 25% des médecins. Les résidents avaient une connaissance des objectifs de leur formation en urologie et andrologie: 68,7% connaissaient les objectifs des cours théoriques. 87,5% participaient aux cours magistraux organisés. 62,5% connaissaient les objectifs pratiques. 93,7% connaissaient les modalités de l'évaluation en fin d'année. La première source de documentation était faite de document sur support numérique (CD, DVD, ordinateur, sites internet) 43,7%. Dans le calendrier hebdomadaire, 75% des résidents avaient assisté à des consultations assurées par un senior. 93,8% avaient participé à un staff de programmation opératoire. Sur un mois, la fréquence d'assistance au bloc opératoire comme premier aide opératoire avait une médiane de 4 (1­10). Une personne sur 15 a bénéficié régulièrement de débriefing après la réalisation d'un acte de soins. La durée de travail quotidien hospitalier était comprise entre 4h et 8h pour 68,9% des résidents. CONCLUSION: L'avis des médecins en formation sur les compétences urologiques souligne la nécessité de soutenir le développement du DES d'urologie et d'andrologie à Cotonou.

[Assessment of quality in day-case hand surgery]. / Démarche d'assurance qualité en chirurgie ambulatoire de la main.

OBJECTIVE: To determine the level of satisfaction in terms of pain relief and comfort among patients receiving different postoperative analgesia protocols after hand surgery under regional anaesthesia in a day care unit. METHODS: Cohort study among patients after hand surgery under regional anaesthesia during two consecutive three months time periods, with patient stratification according to the expected pain level with different balanced analgesia protocols (group A: carpal tunnel, group B: other surgery without bone involvement, group C: bone surgery). A telephone survey, scoring analgesia and comfort, each with a numerical (0-10) scale was conducted on days 1 and 7. During the first period analgesia for groups A and B was the same (acetaminophen-dextropropoxyphene or acetaminophen-codeine) and group C patients were treated with acetaminophen-ketoprofen-tramadol. In the second period analgesia was reduced for group A (acetaminophen alone) and increased for group B (acetaminophen-ketoprofen-tramadol) and group C (duration increased from 3 to 7 days). RESULTS: For carpal tunnel surgery, analgesia with acetaminophen alone was efficient, (Pain scale [PS] d0=2[0-10], PS d1=1 [0-10] and PS d2-d4=0,5 [0-10]). This surgery does not elicit important pain, there is no benefit in adding other analgesics. For group B, a significant improvement in postoperative pain was observed (postoperative d1 p<0.03) with a major increase in side effects (2/57 vs 17/48 p<0.001). For group C, therapeutic changes were ineffective (PS d0=2 vs 3.5 et PS d1=3 vs 5 [NS]) and we noticed an increase in side effects (p<0.05). One third of all patients are totally satisfied on day 7, logistic regression showing the role of inefficient analgesia in late postoperative period (PS>2 between d2-d4). Between day 1 and day 7, 20% of the patients change their point of view, those who feel less satisfied on day 7 complained of a more severe postoperative pain between day 2 and 4 (p<0.001) and between day 5-7 (p<0.01). CONCLUSION: For hand surgery on day case, quality of late postoperative analgesia (day 2-day 7) is strongly related to patient's satisfaction on day 7.

[Assessment of patient satisfaction after regional anaesthesia in two institutions]. / Evaluation de la satisfaction des patients ayant bénéficié d'une anesthésie locorégionale par bloc nerveux périphérique: étude bicentrique sur 314 cas.

OBJECTIVES: This study was designed to assess patient satisfaction after regional anaesthesia for limb surgery. METHODS: An anaesthesia satisfaction questionnaire was developed, validated (Kappa coefficient) and submitted to 314 patients operated in two institutions (one university hospital with anaesthesiology residents and one specialised in orthopaedics with experienced anaesthesiologists). Items explored were information modalities, pain and anxiety during procedure and global satisfaction rated with four levels (very satisfied [VS], satisfied [S], partially satisfied [PS], non-satisfied [NS]). Patients were interviewed by telephone at postoperative D1 and D8 by a pharmacist student not involved in the patient's care. RESULTS: Inspite of a high level of patient satisfaction at D8 (VS: 50%, S: 44%), some interesting aspects should be emphasised: a) sedation given before nerve block was not efficient to reduce anxiety and pain during procedure; b) VS levels decreased from D1 (56%) to D8 (50%) mainly because of late postoperative pain (after discharge) and discomforts; c) willingness to undergo the same nerve block again (294/314) was not correlated with patient's satisfaction since among PS and NS patients, a majority (9/15) wished for a block in case of renewed limb surgery; d) multivariate analysis showed that VS level was highly correlated with the quality of communication by the anaesthesiologist mainly for informations about pre and postoperative periods. No correlation was found with pain level during procedure; e) satisfaction levels were not different in the two institutions. CONCLUSION: This study has emphasised some important factors of patient satisfaction which were not sufficiently taken into account in our daily practice.

[Evaluation of the demand for access to peridural obstetrical anesthesia in maternity units]. / Evaluation de la demande et de l'accès à la péridurale de travail dans une maternité de niveau III.

OBJECTIVES: This prospective study was initiated by a multicentric work. Each participating hospital, was asked to give data about 20 patients. Because of the importance of these informations for our practice, we decided to continue the evaluation, using the same inquiry, until 200 patients were enrolled. PATIENTS AND METHODS: An independent student (resident pharmacist), using a preprinted inquiry from interviewed two hundred consecutive in the, 48 hours after delivery in order to evaluate the following aspects: reasons to wish an epidural analgesia (EA) or not, modalities of achievement of EA. Statistical study: Chi-square and logistic regression. RESULTS: Among 199 analyzable files, 137 women wished for an EA (68.5%) but in only 90 the procedure was performed. Reasons for non-achievement of EA were the following: labour too advanced (43/47), obstetrical contraindication (2/47), anaesthesiologist non available (2/47). Delay between arrival at hospital and EA performance was 5 h 30 during daytime and 4 h 40 during nighttime. Delay and rate of EA achievement were not different between day and night time. Logistic regression analysis found following criteria related to: Wish for an EA analgesia: anaesthesiology consultation (OR = 193, p < 0.001), nulliparity (OR = 4, p < 0.002) and satisfactory information about EA (OR 35, p = 0.051). Achievement of EA: nulliparity (OR 38, p < 0.002), length of labour (OR = 1.01/min, p < 0.001). CONCLUSION: This study underlined the fact that one third of parturients do not wish for an epidural analgesia, mainly out of fear for neurological complications. When the obstetrician indicated an EA, our organisation allowed its achievement in 98% of cases. The latency between arrival and EA should be shortened.

Early assessment of transplanted liver function: lignocaine clearance test (MEGX).

The purpose of this study was to assess the value of lignocaine biotransformation into monoethylglycinexylidide (MEGX) and conventional liver function tests in the early post-operative period as an indicator of graft function and as a diagnostic tool for complications after hepatic transplantation. Monoethylglycinexylidide formation, plasma bilirubin, aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), factor V index (FVI) and prothrombin time index (PTI) were measured in 71 patients undergoing 80 liver transplantations respectively at 12 (T1), 24 (T2), 48 (T3) and 72 h (T4) after liver graft revascularization. Patients were divided into two group according to the post-operative outcome. Patients with favourable outcome (n = 59) had significantly higher monoethylglycinexylidide synthesis, higher factor V index and prothrombin time index plasma concentrations, lower bilirubin, ASAT and ALAT plasma concentration (P < 0.0001 at T2 and T3) than those with complicated time course (n = 21). Monoethylglycinexylidide synthesis was the best discriminant of a favourable outcome, whereas bilirubin and ALAT concentrations were associated with complications (bilirubin for primary non function [PNF], ALAT for acute rejection). Thus, the combination of parameters at T2 was a very efficient predictor of primary non function, acute rejection and an uncomplicated time course.