ABSTRACT
BACKGROUND: Practice-based research is one of the levers identified by the World Health Organization (WHO) to strengthen primary health care. The scaling of health and social care innovations has the potential to reduce inequities in health and to expand the benefits of effective innovations. It is now rapidly gaining the attention of decision-makers in health and social care, particularly in high-income countries. To meet the challenge of declining numbers of primary care physicians in France, Multi-professional Healthcare Centers (MHC) were created to bring together medical and paramedical professionals. They are a source of innovation in meeting the health challenges facing our populations. Specific methodology exists to identify health innovations and assess their scalability. A working group, including end-users and specialists, has adapted this methodology to the French context and the University department of general practice of Montpellier-Nîmes (France) launched a pilot study in Occitanie, a French region. OBJECTIVE: To identify and evaluate the scalability of innovations produced in pluri-professional healthcare centers in the Occitanie region. METHODS: A pilot, observational, cross-sectional study was carried out. The SPRINT Occitanie study was based on a questionnaire with two sections: MHC information and the modified Innovation Scalability Self-Administered Questionnaire (ISSaQ), version 2020. The study population was all 279 MHC in the Occitanie region. RESULTS: 19.3% (54) of MHC in the Occitanie region, responded fully or incompletely to the questionnaire. Four out of 5 U-MHCs were represented. Five MHC presented multiple innovations. The average per MHC was 1.94 (± 2.4) innovations. 26% of them (n = 9) had high scalability, 34% (n = 12) medium scalability and 40% (n = 14) low scalability. The main innovation represented (86%) were healthcare program, service, and tool. CONCLUSIONS: In our cross-sectional study, a quarter of the innovations were highly scalable. We were able to demonstrate the importance of MHC teams in working on primary care research through the prism of innovations. Primary-care innovations must be detected, evaluated, and extracted to improve their impact on their healthcare system.
Subject(s)
Primary Health Care , Cross-Sectional Studies , France , Humans , Pilot Projects , Surveys and Questionnaires , Diffusion of Innovation , Organizational InnovationABSTRACT
Since 1220 in Montpellier the human cadaver dissection had been used for the teaching of anatomy. In the first time the anatomy was based on animal knowledge. Vesalius student in Montpellier then in Italy, written the first book on human anatomy. Among teachers some of them made discoveries such as Pecquet on cisterna chyli, Vieussens on brain and hearth. Wax anatomy was used for teaching and Laumonier and B. Delmas presented some very nice pieces. Progressively a lot of anatomical preparations were exposed in a conservatory with 2330 human cadavers' dissections obtained during a lot of examinations. Anatomy and pathology were developed by Delpech about growing of bones with laws. In 1953 two anatomist surgeons, Rapp and Couinaud, described the segmentation of the liver with using techniques of corrosion. In the conservatory 250 corrosions of the livers are exposed, this is certainly the most numerous in the world and it represents a huge basis for surgery and liver transplantation. Since 1900 the teaching of anatomy continued with blackboard lectures and Human cadavers dissections. Therefore, a new approach of anatomy with computer is going to be used in the future.
Subject(s)
Anatomy/education , Teaching/history , Universities/history , Anatomy/history , Cadaver , Dissection/history , France , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , History, Medieval , Humans , Models, AnatomicABSTRACT
BACKGROUND Technical innovations allow endoscopic nipple-sparing mastectomy (NSM), which is well tolerated and associated with greater patient satisfaction. Endoscopic technique did not have wide diffusion; many centers have abandoned this technique because of technical challenges. Implant-based reconstruction (IBR) remains the most common form of breast reconstruction. Current techniques involve partial or total coverage of the implant with pectoralis major muscle to prevent exposure or infection. Muscle dissection has functional and cosmetic consequences. CASE REPORT We present a case of 45-year-old patient presenting with personal history of right breast cancer. The patient requested left prophylactic mastectomy. We used a 4 cm-long single hidden scar on axillary line. Endoscopic nipple-sparing mastectomy was done using a single port with 3 sleeves. Immediate breast reconstruction was performed by inserting a silicon implant in prepectoral plane without Acellular Dermal Matrix (ADM). At 6 months postoperatively, no complication had been reported. The patient was satisfied with the result and no further correction was necessary. CONCLUSIONS Endoscopic surgery is a valuable option for nipple-sparing mastectomy. This method is a less expensive alternative technique to robotic approach. It could enable safe prepectoral IBR without placement of ADM and with lower risk of complications.