Speculum self-insertion: an alternative method for gynaecological examination?

BACKGROUND: Speculum examination is an intrusive practice in the clinical care of women. It requires privacy and patients may experience discomfort or anxiety related to the procedure, which can result in delays or avoidance of necessary healthcare. Speculum self-insertion originated in the United States in the 1970s as part of the self-help movement. However, this clinical practice is largely unknown among healthcare providers and has rarely been assessed. AIM: This study investigates the women's views and healthcare providers' experiences of the self-insertion method. METHOD: A qualitative study was conducted between December 2021 and October 2022, including fieldwork combining semi-structured interviews (10 women) and focus groups associated with individual interviews of 13 healthcare providers. The data collected were independently coded by 2 authors and analysed using an inductive approach and grounded theory method. RESULTS: Speculum self-insertion was described as a way to decrease discomfort and facilitate speculum insertion. Self-insertion was proposed as a means of allowing women to participate in the examination, reducing their vulnerability against power imbalances in the doctor-patient relationship. Both patients and healthcare providers have reported that speculum self-insertion is a method that can contribute to improving trust and communication during the examination. CONCLUSION: The practice of speculum self-insertion during the consultation is an alternative to traditional practitioner insertion and may be offered to all women by any practitioner who wishes to use this technique.

The use of a speculum is common in gynaecological consultations and most women are likely to encounter this tool during a medical examination. Several studies have already shown that this examination can cause pain and anxiety. Speculum self-insertion is not widely used and consists of allowing the woman to insert the speculum herself while being assisted by the practitioner. A study was conducted with 10 women and 13 healthcare providers to evaluate this technique and its impact on women's healthcare. This technique reduces the discomfort that can be felt during the examination. The woman will regain control of her body during the examination and this technique will reduce the hierarchical relationship felt by some women. A discussion about the gynaecological examination and women's healthcare is created during the consultation. Even if this technique does not seem to be suitable for all women, routinely offering self-insertion allows the healthcare provider to adapt to each woman and to her choice. The proposal of speculum self-insertion is an alternative technique that can improves women's feelings and their overall health.

What interventions do firefighter nurses carry out? / Quelles interventions effectuent les Infirmiers Sapeurs-Pompiers ?

INTRODUCTION: With the rarefaction of home medical visits, prehospital emergencies are ensured by the Mobile Emergency and Resuscitation Structures (SMUR) and the Firemen accompanied by Firefighters Nurses (FfNs). PURPOSE OF RESEARCH: The main objective of this work is to describe the pathologies managed by the FfNs of the Loire district according to their International Classification of Primary Care version 2 and the Clinical Classification of Diseases of the initial SMUR during all interventions performed in 2019. The secondary objective will be to determine the associated Emergency Care Nursing Protocols (PISU). RESULTS: Among the 2969 interventions and 5036 PISU performed, trauma and polytrauma are the most common pathologies treated. Outside of trauma, the most frequent conditions are chest pain, carbon monoxide poisoning, and cardiopulmonary arrest (CPA). Analgesic protocols are the most used PISU and in second place comes the absence of PISU application, chest pain protocols, adult CPA and glucose administration. CONCLUSIONS: FfNs occupy an increasingly important place in the French rescue chain. Thanks to a wide range of interventions and a great autonomy of action, they make it possible to greatly limit the number of SMUR medical teams leaving the hospital, especially in situations that do not require a doctor immediately.

Introduction: Avec la raréfaction des visites médicales à domicile, les urgences préhospitalières sont assurées par les Structures Mobiles d'Urgence et de Réanimation (SMUR) et les Sapeurs-Pompiers accompagnés d'Infirmiers Sapeurs-Pompiers (ISP). Objectifs: L'objectif principal de ce travail est de décrire les pathologies prises en charge par les ISP de la Loire en fonction de la Classification internationale des soins primaires version 2 et de la Classification Clinique des Malades du SMUR initiales, lors de toutes les interventions effectuées en 2019. L'objectif secondaire sera de déterminer quels Protocoles Infirmiers de Soins d'Urgence (PISU) sont mobilisés. Résultats: Parmi les 2 969 interventions et 5 036 PISU réalisés, les traumatismes et polytraumatismes sont les pathologies les plus prises en charge. Hors traumatologie, les plus fréquentes sont les douleurs thoraciques, « les expositions aux fumées d'incendie ¼ et les arrêts cardio-respiratoires (ACR). Pour les PISU, les protocoles d'antalgies sont les plus utilisés et en seconde position vient l'absence d'application de PISU, les protocoles douleur thoracique, l'ACR de l'adulte et le resucrage. Conclusions: Les ISP occupent une place de plus en plus importante en France dans la chaîne des secours. Grâce à un domaine d'intervention large et une grande autonomie d'action, ils permettent de limiter grandement les sorties des équipes médicales du SMUR, notamment dans des situations qui ne nécessitent pas de médecin immédiatement.

[Evaluation of 114 abnormal Pap smear follow-up in ambulatory care.] / Évaluation du suivi de 114 femmes ayant présenté un frottis cervico-utérin pathologique en ambulatoire.

AIM: In France, cervical cancer screening has led to a decrease in mortality, though it could be optimized by improving the management of abnormal cytology. The aim was to evaluate the follow-up of women with abnormal Pap smear prescribed by an ambulatory health professional, compared to the ANAES guidelines of 2002. METHOD: Quantitative monocentric and retrospective study of 120 women with abnormal Pap smear performed before October 2014 in the French department of the Loire. RESULTS: 114 abnormal Pap smear follow-ups of women between the ages of 18 and 75 have been analyzed. Cytological abnormalities were spread among 90 ASC-US (79%), 16 LSIL (14%), 6 HSIL (5,3%) and 2 ASC-H (1,7%). Compared to the ANAES guidelines, 52% of follow-ups were incomplete, 24% were comprehensive with too long of a delay, and 24% were guidelines compliant. Women under 29 were more likely to have an incomplete follow-up: OR 0,306 [0,116-0,805]. CONCLUSION: In our sample, the analysis of the follow-ups of women with abnormal Pap smear has reflected over screening and lack of conformity, eventually allowing the screened lesion to progress towards cancer. A national screening program could help to improve the quality of a follow-up for these women.

Physical Activity in Long COVID: A Comparative Study of Exercise Rehabilitation Benefits in Patients with Long COVID, Coronary Artery Disease and Fibromyalgia.

Exercise in long COVID is poorly studied. Nevertheless, exerciserehabilitation could improve cardiorespiratory, muscular and autonomic functions. We aimed to investigate improvement in physical and autonomic performances of long COVID patients (n = 38) after a 4-week exercise rehabilitation program (3 sessions/week) compared to two control groups composed of coronary artery disease (n = 38) and fibromyalgia patients (n = 38), two populations for whom exercise benefits are well known. Efficacy of exercise training was assessed by a cardiopulmonary exercise test, a handgrip force test, and a supine heart rate variability recording at rest before and after the rehabilitation program. Cardiorespiratory and muscular parameters were enhanced after exercise rehabilitation in the three groups (p < 0.001). No significant difference was observed for the autonomic variables. Through this comparative study with control groups, we confirm and reinforce the interest of caring for long COVID patients without post-exertional symptom exacerbation by exercise rehabilitation of both strength and endurance training, by personalizing the program to the patient and symptoms.

Prevalence of cardiovascular risk factors in a population of French firefighters.

Firefighters' activities increase the risk of sudden cardiac events. The main objective of this study was to describe the Loire firefighters' cardiovascular risk factors according to their cardiovascular risk and to their professional status. A retrospective study of the entire population of firefighters of the Loire department was conducted. Risk factors derived from the data collected during the occupational health follow-up medical examinations were described and the cardiovascular risk was assessed for 417 firefighters. The most frequent cardiovascular risk factors were: overweight and obesity (62.1%), high blood pressure (27.8%) and active smoking (16,1%). There were no significant differences between career firefighters and volunteers. The prevalence of risk factors for cardiovascular diseases is less than in the general population. Obesity remains the most common risk factor, especially among firefighters with high cardiovascular risk.

Sleep quality and sleep disturbances among volunteer and professional French firefighters: FIRESLEEP study.

BACKGROUND: Although insufficient sleep among firefighters reduces work efficiency and increases the risk of injury, little is known about the sleep quality of French firefighters in the Loire department. The aim of the FIRESLEEP study was to evaluate sleep quality and sleep disturbances among professional and voluntary French firefighters. METHODS: A cross-sectional observational study was conducted between November 2018 and May 2019. Firefighters were invited to complete a questionnaire on a secure platform including clinical questions and validated questionnaires (Pittsburgh Sleep Quality Index [PSQI], Epworth sleepiness scale [ESS], Insomnia Severity Index [ISI] and the STOP-Bang score) during their periodic medical examination. RESULTS: 193 firefighters were included in this study, of which 29% were of professional status and 71% were volunteer firefighters. Among them, 26.9% had poor sleep quality, 27.7% showed excessive daytime sleepiness (EDS), 18.8% reported moderate-to-severe symptoms of insomnia, and 1.6% had moderate-to-high risk of obstructive sleep apnea. Subgroup analysis revealed that professional firefighters had poorer sleep quality and higher sleep disturbances than volunteer firefighters. The independent risk factors associated with poor sleep quality were known sleep disorder, treated anxiety/depression, night calls, and insomnia symptoms. Moreover, the independent risk factors associated with EDS were short sleep duration, taking a nap, and insomnia symptoms; while older age was a protective factor for EDS. CONCLUSIONS: Poor sleep quality and sleep disturbances are highly frequent in French firefighters and underdiagnosed. Prevention through education and systematic screening could limit the impact of sleep disturbances on firefighters' global health.

Graduated compression stockings in prevention of venous thromboembolism among acutely ill medical patients aged over 75 years: a French national survey.

Background: The thromboprophylactic efficacy of graduated compression stockings (GCS) has not yet been demonstrated in acutely ill medical patients, and guidelines vary considerably. Older acutely ill medical patients appear to constitute a distinctive population presenting high risks of both thrombosis and bleeding. Objective: To evaluate the practices and beliefs of a panel of French geriatricians regarding GCS management in acutely ill medical patients aged over 75 years. Methods: A survey was designed to study French geriatric practice concerning GCS use for thromboprophylaxis. Results: A total of 111 geriatricians answered the questionnaire. Among the responders, 46% declared frequent or very frequent prescription of GCS for preventing venous thromboembolism (VTE) in acutely ill, hospitalized medical patients, 54% declaring that they frequently re-evaluated GCS prescription during the patient's hospitalization. The main reason reported for discontinuing GCS use was patient request. Regarding complications of GCS, 87% of responders declared having already noted adverse effects with the use of GCS, although 80% estimated the risk of complications to be low or very low. In the context considered, the efficacy of wearing GCS was believed to be high or very high for 73% of responders. GCS prescription was judged to be in accordance with evidence-based medicine for 69%. Conclusion: There is a gap between the frequent use of GCS to prevent VTE in older patients presenting an acute medical illness and the availability of data concerning their efficacy, safety, and management by nurses. Prospective trials including clinical and cost effectiveness are needed.

Volunteer and Career French Firefighters With High Cardiovascular Risk: Epidemiology and Exercise Tests.

OBJECTIVE: We aim to identify cardiovascular risk factors in firefighters of Loire (French district) with a high cardiovascular risk and report results of a screening program using exercise tests. METHODS: A retrospective descriptive study was performed in a cohort of 158 career and 400 volunteer firefighters with a high cardiovascular risk who had undergone an exercise test. RESULTS: Five hundred fifty-eight exercise tests and cardiovascular profiles were analyzed. Prevalence was 18% for high blood pressure, 19% for dyslipidemia, and 48% for overweight. Exercise tests were positive in 91 cases (16.3%): sensitivity, 53%; specificity, 74%. Risk of onset of a predictive event was higher in the high-risk group: odds ratio, 3.2 (95% confidence interval 2.0 to 5.1). There were more events on exercise test in volunteer firefighters. CONCLUSION: Prevalence of cardiovascular risk factors in the cohort of firefighters was acceptable in comparison to French general population and other firefighters' cohort. Physical training of volunteer firefighters needs reinforcing.