[Use of simulation in healthcare for therapeutic training of the parents of children with hereditary angioedema]. / Utilisation de la simulation en santé pour l'éducation thérapeutique des parents d'enfants souffrant d'un angio-œdème héréditaire.

BACKGROUND: C1INH-deficiency hereditary angioedema (HAE) is characterized by recurrent episodes of potentially severe oedema. Icatibant for SC injection will soon be approved for use in children and it is necessary to train parents in recognising severe episodes of AOH and in the technique for injection of icatibant. Simulation in healthcare (SH) is a set of educational methods for improving skills in a safe environment. We wished to assess the feasibility of a therapeutic training session (TTS) involving scripted scenarios for the parents of children with HAE. PATIENTS AND METHODS: The TTS session included pre- and post-training testing on AOH, two scenarios (calling emergency services for lingual AO; gastrointestinal AO) involving actors and a volunteer parent, a workshop for learning the SC injection technique, and a satisfaction questionnaire. We analysed the answers on the questionnaire and noted down parents' verbatim observations during debriefing sessions. RESULTS: Eight parents from 5 families took part in this session. Parents rated their overall satisfaction as 9.3/10. The parents commented that during the simulations, they felt "in the thick of it" and that they "experienced stress while viewing the scenes", thus attesting to the realism and relevance of the simulated scenarios. DISCUSSION: This session met the parents' expectations in terms of being able to cope and having adequate know-how, based on both the simulations and the level of knowledge acquired. The main limitation lay in the parents' difficulty in confronting certain situations reminiscent of traumatic past experiences. TTS shares many common features with SH for the parents of sick children. The place of the latter in TTS must be evaluated.

Taming hazardous chemistry by continuous flow technology.

Over the last two decades, flow technologies have become increasingly popular in the field of organic chemistry, offering solutions for engineering and/or chemical problems. Flow reactors enhance the mass and heat transfer, resulting in rapid reaction mixing, and enable a precise control over the reaction parameters, increasing the overall process selectivity, efficiency and safety. These features allow chemists to tackle unexploited challenges in their work, with the ultimate objective making chemistry more accessible for laboratory and industrial applications, avoiding the need to store and handle toxic, reactive and explosive reagents. This review covers some of the latest and most relevant developments in the field of continuous flow chemistry with the focus on hazardous reactions.

[Simulation training: a pilot-study on reception of parents in a pediatric intensive care unit]. / Formation par la simulation : étude-pilote sur l'accueil des parents par une équipe de réanimation pédiatrique.

BACKGROUND: Simulation training is gradually being integrated into the curriculum for caregivers in intensive care units. There are few training programs on communication with families. GOAL: This pilot-study evaluated the impact of a training protocol on professional practices including a protocol for the reception of the parents of a child admitted to a pediatric intensive care unit. MATERIALS AND METHODS: The training program lasted 3 months and included three parts: a theoretical contribution, a simulation session with debriefing, and a focus group. During the simulation session, a multi-professional team of three healthcare providers (physician, nurse, assistant nurse) must apply a protocol for the reception of the parents of a child who had just been admitted. The protocol lasted 35 min and included three sequences: reception and dressing by the assistant nurse, medical meeting conducted by the physician and the nurse, support of the parents in the room by the nurse and the assistant nurse. The child was simulated by a manikin (SimBaby™, Laerdal) and the parents were prepared actors. The main objective of the pilot-study was to measure the rate of change in professional practices 1 year after the end of training. RESULTS: One year later, all healthcare providers (n=15) declared they had changed their professional practices and felt that half of these changes were due to the pilot-study. New practices such as receiving parents in pairs in a dedicated room or managing a short interview with the parents before supporting the child were applied "always" or "if possible". CONCLUSION: The pilot-study showed that the training program induced half of the changes of professional practices for welcoming the parents of a child admitted to pediatric intensive care unit 1 year later.

[Evaluation of the impact and efficiency of high-fidelity simulation for neonatal resuscitation in midwifery education]. / Évaluation de la simulation haute-fidélité dans la formation initiale à la réanimation en salle de naissance chez les étudiants sages-femmes.

BACKGROUND: Prompt initiation of appropriate neonatal resuscitation skills is critical for the neonate experiencing difficulty transitioning to extra-uterine life. Expertise in neonatal resuscitation is essential for personnel involved in the care of newborns, above all for midwives who are sometimes alone to initiate the first resuscitation. The use of simulation training is considered to be an indispensable tool to address these challenges, not only in continuing education but also in midwifery education. OBJECTIVE: The aim of this study was to evaluate the impact and efficiency of high-fidelity simulation for neonatal resuscitation in midwifery education. METHODS: This was a prospective monocentric study conducted in the Angers university hospital between October and December 2012 and included two groups of midwifery students (n=40) who received high-fidelity simulation as part of their basic midwifery education. Participants' perceptions of the knowledge, skills, and confidence gained following training in high-fidelity simulation for neonatal resuscitation were determined using a pre-/post-test questionnaire design completed during the training and also several months after the course, as well as after the students had begun working. A satisfaction survey to evaluate this training was also completed at the same time. RESULTS: With a good participation rate (67.5%), the survey showed a high degree of satisfaction among the participants. This training was described as facilitating their hire in one third of cases. A significant increase in self-assessment of skills scores was observed between the pre-test and post-test (P<0.001), the pre-test and the distance test (P<0.001), and the post-test and distance test (P=0.007). Although a decrease in the median score was observed on the knowledge questionnaire given as a post-test, this median remained significantly higher than that obtained on the pre-test (P=0.03). CONCLUSION: The significant improvement in knowledge during the session and its preservation after a few months confirmed the efficacy of this teaching method. The simulation training increased the participants' perceptions of their knowledge, skills, and confidence in conducting neonatal resuscitation. These preliminary results are very encouraging and argue in favor of generalizing this teaching method. However, this training could be more profitable if it was proposed earlier in the midwifery curriculum and organized with a multidisciplinary team (pediatric and anesthesia residents).

[Medical paediatric simulation: a European survey]. / Enquête européenne sur la pratique de la simulation médicale pédiatrique.

OBJECTIVE: To present the effective applications of paediatric medical simulation in terms of education, evaluation, density, development, goals and constraints. STUDY DESIGN: Survey realized within 38 paediatric simulation centres (PSC) in Europe, identified by Web search and through the Society in Europe for Simulation Applied to Medicine (SESAM. RESULTS: Twenty centers answered the questionnaire (52%). Ninety-four percent of the PSC had beforehand acquired an experience of adult medical simulation, 94.6% of the PSC were created before 2006. Ninety percent of the PSC owned at least one high-fidelity pediatric simulator. The 80% of the PSC indicated multiple funding sources. Eighty percent of the PSC had at least one specific instructor for the paediatric simulation (average=2.7 paediatric instructors per centre). The PCS reported to get onto various topics: neonatology (25% of the PCS), prehospital medicine (36.8%), paediatric anaesthesiology (74%) and paediatric intensive care (89%). Simulation allowed 70% of the centers to lead some research project. Ninety-five percent of the centers agreed about an European collaboration on research projects or about the mutualization of the created scenarios. CONCLUSION: The material, financial and human means of the interviewed centres are consequential but heterogeneous in Europe. MSP offers numerous and various application fields and generates some research activity.

Quality of anaesthesia-related information accessed via Internet searches.

BACKGROUND: We conducted a study to examine the quality and stability of information available from the Internet on four anaesthesia-related topics. METHODS: In January 2006, we searched using four key words (porphyria, scleroderma, transfusion risk, and epidural analgesia risk) with five search engines (Google, HotBot, AltaVista, Excite, and Yahoo). We used a published scoring system (NetScoring) to evaluate the first 15 sites identified by each of these 20 searches. We also used a simple four-point scale to assess the first 100 sites in the Google search on one of our four topics ('epidural analgesia risk'). In November 2006, we conducted a second evaluation, using three search engines (Google, AltaVista, and Yahoo) with 14 synonyms for 'epidural analgesia risk'. RESULTS: The five search engines performed similarly. NetScoring scores were lower for transfusion risk (P < 0.001). One or more high-quality sites was identified consistently among the first 15 sites in each search. Quality scored using the simple scale correlated closely with medical content and design by NetScoring and with the number of references (P < 0.05). Synonyms of 'epidural analgesia risk' yielded similar results. The quality of accessed information improved somewhat over the 11 month period with Yahoo and AltaVista, but declined with Google. CONCLUSIONS: The Internet is a valuable tool for obtaining medical information, but the quality of websites varies between different topics. A simple rating scale may facilitate the quality scoring on individual websites. Differences in precise search terms used for a given topic did not appear to affect the quality of the information obtained.

Isolation of prostatic kallikrein hK2, also known as hGK-1, in human seminal plasma.

To demonstrate the presence of kallikrein hK2 in the human prostate and seminal plasma, we used mouse monoclonal antibodies (MAb) against a recombinant hK2-fusion protein. Using one of these MAb 9D5, we detected the presence of several major immunoreactive spots of 22 kDa and minor ones of 31 and 55 kDa in prostate cytosol and seminal plasma. After ion exchange and immunoaffinity chromatography of seminal plasma proteins, the 22-kDa immunoreactive proteins were isolated along with 55- and 75-kDa proteins. The NH2-terminal amino acid sequencing permitted identification of fragments of hK2 and protein C inhibitor, respectively, in the 22- ad 55-kDa bands. Furthermore, immunoblotting experiments in one and two-D gels with two different anti-hK2 MAbs and one polyclonal anti-PCI antibody suggested that the major 55- and 75-kDa bands were covalent hK2-PCI complexes containing either the full-length hK2 chain or only its carboxyterminal fragment in the presence of mercaptoethanol. These results demonstrate for the first time the existence of kallikrein hK2 and suggest that PCI may regulate its activity in seminal plasma.

Does palytoxin open a sodium-sensitive channel in cardiac muscle?

The effect of palytoxin (PTX) on transmembrane potentials and currents of frog atrial fibres was studied using the double sucrose gap technique. PTX irreversibly depolarized the membrane. This depolarization was reversed only when Na ions were removed from the Ringer solution and replaced by a non-permeant cation such as choline. The depolarization was tetrodotoxin (TTX) insensitive and a function of the external Na concentration. In voltage clamp experiments PTX induced the development of a large inward resting current which did not inactivate and was insensitive to ouabain and to a lowering of the temperature. PTX and ouabain did not share the same receptor. Dose-response curves indicated a stoichiometry of 2, which suggested the aggregation of 2 molecules of PTX to form a channel. The channel formed by PTX remained insensitive to TTX, 4 aminopyridine, tetramethyl-ammonium, Cs and Cd, the classical blockers of Na, K and Ca conductances. PTX reduced the Na current, but not the apparent reversal potential for Na ions. It was concluded that PTX might act on frog atrial fibres as a Na ionophore.

[Application of the double sucrose gap technique to the study of sodium conductance of false tendons isolated from the rabbit ventricle]. / Application de la technique de la double partition de saccharose à l'étude de la conductance sodium des faux tendons isolés du ventricule de lapin.

The double sucrose gap technique was used to study the Na conductance in ventricular false tendons of rabbits. It has been shown that it is possible to correctly measure the Na conductance of this preparation using this technique.

[Radiation-induced coronary artery disease. One observation (author's transl)]. / Etude des coronaropathies post-radiques. Une observation.

Twenty-seven reports (26 from the literature) of radiation ischemic heart diseases are studied in order to specify their clinical and pathological findings and their natural history. This complications appear after treatment of radiation-curable diseases with a mean delay of 4 years in young patients (mean age of 31). Several coronary arteries are often injured with fibrous and or atherosclerotic anatomical lesions. The frequency of this coronary artery diseases is certainly more important than reported since they are often latent but probably progressive. However, atherogenic factors increase the risk and must be lowered in a preventive aim; as a rule, the radiotherapeutic technique must also be as perfect as possible. The prognosis of this radiation induced coronary artery diseases is poor: 19 myocardial infarctions and 12 deaths are observed but no cardiac death occurred in patients who received a by-pass graft. So, radiation ischemic heart disease needs active investigation and therapy.