["Wellness Bubbles" for caregivers, a way to improve the quality of life at work]. / Les "Bulles de bien-être" pour les soignants, une piste pour améliorer la qualité de vie au travail.

Improving the well-being at work of caregivers is a major challenge for our healthcare system. Both global and local solutions must be proposed. At the Marie-Lannelongue hospital, located in the Paris region, a structure dedicated to the well-being of caregivers at work, the "Bubble", has been set up. How does it work and what are its beneficial effects? How have the professionals received it? Is it an example to follow? These are some of the questions that a survey has enabled us to answer.

Continuous or discontinuous tranexamic acid effectively inhibits fibrinolysis in children undergoing cardiac surgery with cardiopulmonary bypass.

Tranexamic acid is given continuously or discontinuously as an anti-fibrinolytic therapy during cardiac surgery, but the effects on fibrinolysis parameters remain poorly investigated. We sought to assess the effects of continuous and discontinuous tranexamic acid on fibrinolysis parameters in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Children requiring cardiac surgery or repeat surgery by sternotomy with CPB for congenital heart disease were randomized to receive either continuous or discontinuous tranexamic acid. Blood tranexamic acid, D-dimers, tissue plasminogen activator (tPA), tPA-plasminogen activator inhibitor 1 (tPA-PAI1) complexes, fibrinogen and fibrin monomers were measured and compared to values obtained from children who did not receive tranexamic acid. Tranexamic acid inhibited the CPB-induced increase in D-dimers, with a similar potency between continuous and discontinuous regimens. Time courses for tPA, fibrin monomers, and fibrinogen were also similar for both regimen, and there was a significant difference in tPA-PAI1 complex concentrations at the end of surgery, which may be related to a significantly higher tranexamic acid concentration. Continuous and discontinuous regimen are suitable for an effective inhibition of fibrinolysis in children undergoing cardiac surgery with CPB, but the continuous regimen was previously shown to be more effective to maintain stable tranexamic acid concentrations.

[Determinants of clinical priority and of actual waiting times for surgical interventions]. / Determinanti della priorità clinicà e dei tempi effettivi di attesa per interventi di chirurgia generale.

OBJECTIVES: To explore determinants of clinical priority and of actual waiting times for elective surgical interventions. DESIGN, SETTING PARTECIPANTS: 405 patients cared for at two general surgery wards, receiving an explicit judgement of clinical priority and whose actual waiting times to surgery were assessed. Clinicalpriority was assessed through 0 (no priority) to 10 (maximum priority). MAIN OUTCOME MEASURE: Identification through multivariate regression techniques of the clinical characteristics associated with high clinical priority (score 28) and with shorter actual waiting times. RESULTS: Patients with cancer, severe pain, relevant impairment in functional status and relevant expert improvement on quality and duration of survival were more frequently attributed a high clinical priority. As for waiting times, presence of cancer was the only factor associated with shorter waitings. Only for cancer patients high priority judgement was associated with shorter waiting times (median 21 vs. 69 days; p < 0.008). CONCLUSIONS: These findings suggest that actual waiting times are not influenced by the same clinical characteristics that clinicians value when assigning clinical priority. That may have some relevant implications on how waiting lists are managed, if consideration of relevant aspects of patients' needs are missed.

The pain locus of control orientation in a healthy sample of the Italian population: sociodemographic modulating factors.

We studied the pain locus of control orientation of the Italian population and the possible influence of the ethnocultural background and sociodemographic characteristics on this attributional style. An Italian version of the Pain Locus of Control (PLOC-It) scale was administered to 144 healthy subjects, divided into two ethnocultural areas (North vs South) and stratified by age (per decade 21-60), gender (female and male) and educational level (3). The Powerful Other subscale had the highest mean score, followed by the Internality and Chance subscales. ANOVA revealed significant effects of ethnocultural area and educational level on Internality (F = 724, p < 0.001; F = 5.05, p < 0.05) and of age on Chance (F = 13.6, p < 0.001). There was a significant three-way interaction between area, gender and educational level on Powerful Other (F = 3.67, p < 0.05). Further studies should be performed in populations of various countries to better identify the attributional styles related to the different cultures and the absolute sociodemographic determinants of the pain locus of control orientation.