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Resume Bien que la technologie joue un role de plus en plus important dans les systemes de sante moderne, la performance humaine demeure un determinant majeur de la surete, de l’efficacite et de l’efficience des soins delivres aux patients. Ce constat est particulierement operant en salle d’accouchement. Ainsi, la formation des professionnels doit avoir pour objectifs non seulement l’acquisition de la theorie et de la pratique a titre individuelle mais egalement l’apprentissage d’un travail d’equipe s’articulant de maniere coordonnee. L’enseignement par simulation constitue un complement solide de l’enseignement theorique et repond aux exigences de connaissances, des savoir-faire et etre. Ainsi, nous proposons d’explorer comment l’enseignement par simulation dans les situations d’urgence du peripartum est-il actuellement un outil pedagogique incontournable en formation initiale et dans le maintien des connaissances. Nous l’aborderons suivant trois volets : individuelle, collective (equipe) et l’impact de la simulation sur la pratique. Le choix de cette strategie educative permet d’ameliorer les competences cliniques necessaires a une performance optimale dans des environnements complexes, imprevisibles, a fort enjeu, comme la naissance. Neanmoins, l’impact clinique a long terme de l’entrainement sur simulateur reste a explorer, et les modalites de simulation, techniques ou non techniques, conduisant a un benefice direct pour la mere et le devenir neonatal restent a identifier.

Resumo Fundamento: A cardiotoxicidade pode ser uma consequência do tratamento com doxorrubicina (DOX). Objetivos: Verificar o efeito do exercício aeróbio na prevenção da disfunção cardíaca de murinos expostos à DOX. Método: Uma busca abrangente foi realizada em nove bases de dados, em dezembro de 2017. Estudos que avaliaram a função cardíaca de murinos expostos à DOX foram incluídos. O nível de significância adotado foi de 5%. Resultados: Na comparação entre 230 murinos submetidos a exercício aeróbio mais DOX e 222 controles (tratados somente com DOX), a fração de encurtamento mostrou uma melhora de 5,33% a favor do grupo experimental (p = 0,0001). A pressão desenvolvida no ventrículo esquerdo também mostrou um aumento de 24,84 mmHg a favor do grupo de 153 murinos que realizaram exercício em comparação com o grupo controle de 166 murinos (p = 0,00001). Conclusão: Estudos pré-clínicos incluídos nesta metanálise indicaram que o exercício é uma boa estratégia não farmacológica para preservar a função cardíaca pós-DOX. Abstract Background: Cardiotoxicity may be a consequence of treatments with doxorubicin (DOX). Objectives: To investigate the effect of aerobic exercise on the prevention of cardiac dysfunction in murines exposed to DOX. Method: A comprehensive search was conducted in 9 databases in December 2017. Studies that evaluated the cardiac function of murines exposed to DOX were included. The significance level adopted was 5%. Results: In a comparison between 230 murines that underwent aerobic exercise plus DOX treatment and 222 control murines (DOX treatment only), fractional shortening showed an improvement of 5.33% in favor of the experimental group (p = 0.00001). Left ventricle developed pressure also showed an increase of 24.84 mm Hg in favor of the group of 153 murines that performed exercise in comparison to the control group of 166 murines (p = 0.00001). Conclusion: Preclinical studies included in this meta-analysis indicated that exercise is a good nonpharmacological strategy for preserving post-DOX cardiac function.

Introdução: A inatividade física figura como um dos principais fatores associados à mortalidade. Por outro lado, os possíveis prejuízos provocados pelo excesso de exercícios físicos não devem ser negligenciados.Objetivo: Avaliar e comparar o nível de dependência ao exercício entre diferentes modalidades, estimar a prevalência de lesões musculoesqueléticas e a vulnerabilidade imunológica em jovens assintomáticos.Métodos: Estudo observacional. Uma amostra com 219 pessoas foi dividida em cinco grupos: sedentários (e/ou insuficientemente ativos) (n=50), controle (moderadamente ativos) (n=31), praticantes de crossfit superativos (n=45), praticantes de musculação superativos (n=47) e corredores superativos (n=46). Além de uma anamnese para caracterizar a amostra e inferir o número de lesões musculoesqueléticas, gripes e infecções nos seis meses anteriores à coleta de dados, foi utilizada a Escala de Dependência de Exercício. Utilizou-se a ANOVA one way para analisar as diferenças estatísticas e para comparar os níveis de dependência total ao exercício, e a prevalência de lesões musculoesqueléticas, gripes e infecções.Resultados: O grupo musculação apresentou os maiores níveis de dependência ao exercício quando comparado com os grupos sedentários e controle (p

Place: France; OBJECTIVE: To describe perinatal data and to evaluate the neonatal neurological outcome of monochorionic twin pregnancies with selective termination by radiofrequency ablation. METHODS: Retrospective data of perinatal data for nine consecutive monochorionic pregnancies eligible for radiofrequency ablation from January 2013 to August 2015 were collected. A prospective observational study of the neurological outcome of nine children was conducted using the Ages & Stages Questionnaire (ASQ), 2nd edition, French version, adapted to the age. RESULTS: The radiofrequency procedures were performed at a mean gestational age (GA) of 21.4 weeks (±7 weeks). The indications for a selective interruption of a pregnancy were: acardiac twin (n=4), brain malformation (n=1), severe intrauterine growth restriction (IUGR) with massive cerebral ischemia in the context of twin-twin transfusion syndrome grade III (n=1), severe selective IUGR associated with a polymalformative syndrome (n=1) and severe selective IUGR (n=2). The mean GA at birth was 36.7 weeks GA (±3.8 weeks). No infant showed neurological neonatal morbidity. Any ASQ area explored was pathological (\textless-2SD) for the nine children (mean age at follow-up [±SD], 14.8 months [±8.8 months]). CONCLUSION: This work constitutes a preliminary study for developing long-term follow-up and early care programs for those children born subsequent to a radiofrequency ablation for selective reduction.

International audience; Objectives. - To propose a protocol for induction of labor to terminate pregnancy after 22 weeks of amenorrhea allowing to decrease the duration of labor and of hospitalization but also, allowing to reduce the number of emergency pretreatment-induced fetal death, to improve the experience of the patients and to limit the cost. Methods. - We realized a retrospective single-center study including 269 patients and comparing three protocols, with and without laminaria and with various intervals mifepristone-misoprostol (14 and 38 hours). The outcome measures were the misoprostol-delivery interval, the delivery time and the number of emergency pretreatment-induced fetal death. Results. - We showed that the misoprostol-delivery interval and the delivery time were comparable for the three periods of our study, even after decrease of 24 hours of the mifepristone-misoprostol interval and in the absence of laminaria. The misoprostol-delivery interval was between 7 h 30 and 8 h 35 between protocols (P=0.055). The delivery time was between 5:18 pm and 6:48 pm between protocols (P=0.252). The early administration of misoprostol allowed the patients to give birth earlier (P=0.001). Finally, we showed that the increase of the size and the number of laminarias were risk factors of emergency pretreatment-induced fetal death (respectively P=0.013 and P=0.002). Conclusion. - The absence of laminaria and the reduction of the interval mifepristone-misoprostol of 24 hours do not change the time to delivery and allow to reduce the duration of hospitalization, the number of emergency pretreatment-induced fetal death and the cost of the TOP. (C) 2015 Elsevier Masson SAS. All rights reserved.

Introduction: randomized controlled trials are high quality studies. Many problems related to the drafting of these studies have been identified and consequently various national and international journals, in an attempt to improve this writing, have adopted the Consolidated Standards of Reporting Trials recommendations. Regarding the studies written specifically by physical therapists, until now, the quality of the drafting in Portuguese has been unknown. Aim: To critically analyze the drafting of RCTs in the area of physical therapy, published in Portuguese, in relation to the CONSORT recommendations. Materials and Methods: On 17th Oct, 2012, 548 RCTs in Portuguese were recovered from the MEDLINE and PEDro databases, which were divided among four evaluators who, after reading the abstracts, selected those related to physical therapy. Of these studies, 78 RCTs were related to physical therapy, which were divided among the four evaluators for the analysis of the drafting according to the CONSORT recommendations. The four evaluators who participated in this study previously obtained a median kappa above 70% when their analyses were compared to the analyses of the evaluator considered the gold standard due to having greater experience. Results: The quantity of items of the CONSORT recommendations according to year of publication was very small, corresponding to a mean of 43% of the items in the articles analyzed. Conclusion: The results make very clear the need to improve the quality of the drafting of the RCTs related to physical therapy in Portuguese and to include more rigorous methodological procedures, such as sample size, randomization and blinding. The dissemination and adoption of the CONSORT recommendations by physical therapy researchers would, without doubt, be a big step towards improving this quality. Resumo Introdução: os experimentos controlados e randomizados são pesquisas de alta qualidade. Entretanto, muitos problemas relacionados à redação desses estudos foram identificados e em função disso vários periódicos nacionais e internacionais, na tentativa de melhorar essa redação, estão adotando as recomendações Consolidated Standards of Reporting Trials. Em relação aos estudos redigidos especificamente por fisioterapeutas desconhece-se, até o momento, a qualidade das suas redações na língua portuguesa. Objetivo: Analisar criticamente a redação dos ECR, na área da fisioterapia, publicados na língua portuguesa em relação às recomendações CONSORT. Materiais e Métodos: Em 17 Out 2012 foram recuperados 548 ECR em língua portuguesa existentes nas bases MEDLINE e PEDro, que foram divididos entre quatro avaliadores para, após leitura do resumo, selecionarem aqueles sobre fisioterapia. Desses estudos, apenas 78 ECR tinham como escopo a fisioterapia, que foram então divididos entre os quatro avaliadores para a análise da redação conforme as recomendações CONSORT. Os quatro avaliadores que participaram deste estudo obtiveram previamente um kappa mediano acima de 70% quando comparadas as suas análises com as análises do avaliador considerado como padrão-ouro pela sua maior experiência. Resultados: A quantidade de itens das recomendações CONSORT contemplados por ano de publicação foi muito pequena, correspondendo a uma média de 43% dos itens nos artigos analisados. Conclusão: Os resultados encontrados deixam bem evidentes a necessidade de melhorar a qualidade da redação dos ECR em fisioterapia na língua portuguesa. A divulgação e adoção das recomendações CONSORT pelos pesquisadores fisioterapeutas é, sem dúvida, um grande passo no sentido de melhorar esta qualidade.

ObjectiveTo evaluate adherence of obstetricians from our maternity to French practice guidelines concerning information to give to pregnant patients with a history of scarred uterus.Materials and methodsObservational retrospective study performed on medical files from June to August 2014 and concerning women with a scarred uterus that gave live-birth after 37weeks of gestation. Information of patients had to concern the risks of a history of caesarean, the benefits and risks of the various delivery modes.ResultsOn 758 deliveries, 77 cases were studied: 48 patients were followed up from the beginning of pregnancy, 23 from the 2nd trimester and 6 were not followed. Among patients followed from the beginning, no data was written on medical file concerning information that should to be given in immediate post-partum, in preconception counseling, and at the beginning of pregnancy about the risks of scarred uterus and the mode of delivery. In the 8th month, information about benefits and risks of the planned delivery mode was noticed in 45% of files.ConclusionThe information that need in theory to be given to the patients with scarred uterus appeared little or insufficiently noticed on medical files; which can be due either to an inaccurate information, or to a lack of transcription of the information nevertheless given. A check-list in obstetrical file would help to systematize the information to provide in scarred uterus patients., ButLes recommandations pour la pratique clinique (RPC) concernant l’information des patientes présentant un utérus uni- ou bi-cicatriciel sur leur mode d’accouchement ont été actualisées en France en 2012. L’objectif de notre étude a été d’évaluer le suivi des RPC par les médecins obstétriciens de notre maternité.Patientes et méthodesÉtude observationnelle rétrospective réalisée de juin à août 2014 à partir du dossier médical des patientes porteuses d’un utérus uni- ou bi-cicatriciel ayant accouchés après 37SA à la maternité de la Conception à Marseille. L’information des patientes devait porter sur les risques d’un antécédent de césarienne, les bénéfices et risques des différentes voies d’accouchement.RésultatsSur 758 accouchements, 77 dossiers ont été étudiés : 48 patientes avaient été suivies dès le début de la grossesse, 23 à partir du 2e trimestre et 6 n’ont pas été suivies. Parmi celles suivies dès le début, aucune donnée écrite n’a été trouvée sur les dossiers concernant l’information à donner en post-partum immédiat, en pré-conceptionnel et en début de grossesse sur les risques des utérus cicatriciels et le mode d’accouchement. Au 8e mois, 45 % avaient reçu une information sur les bénéfices et risques du mode d’accouchement prévu.ConclusionL’information à théoriquement donner aux patientes en cas d’utérus cicatriciel apparaissait peu ou insuffisamment sur les dossiers médicaux ; cette observation pouvant être due soit à un défaut d’information, soit à un défaut de transcription de l’information pourtant donnée. La mise en place d’une « check-list » dans le dossier obstétrical permettrait la systématisation de l’information à donner aux patientes.

OBJECTIVE: This study investigated the acute hemodynamic responses to multiple sets of passive stretching exercises performed with and without the Valsalva maneuver. METHODS: Fifteen healthy men aged 21 to 29 years with poor flexibility performed stretching protocols comprising 10 sets of maximal passive unilateral hip flexion, sustained for 30 seconds with equal intervals between sets. Protocols without and with the Valsalva maneuver were applied in a random counterbalanced order, separated by 48-hour intervals. Hemodynamic responses were measured by photoplethysmography pre-exercise, during the stretching sets, and post-exercise. RESULTS: The effects of stretching sets on systolic and diastolic blood pressure were cumulative until the fourth set in protocols performed with and without the Valsalva maneuver. The heart rate and rate pressure product increased in both protocols, but no additive effect was observed due to the number of sets. Hemodynamic responses were always higher when stretching was performed with the Valsalva maneuver, causing an additional elevation in the rate pressure product. CONCLUSIONS: Multiple sets of unilateral hip flexion stretching significantly increased blood pressure, heart rate, and rate pressure product values. A cumulative effect of the number of sets occurred only for systolic and diastolic blood pressure, at least in the initial sets of the stretching protocols. The performance of the Valsalva maneuver intensified all hemodynamic responses, which resulted in significant increases in cardiac work during stretching exercises.

Flexibility training responses to distinct stretching techniques are not well defined, especially in the elderly. This study compared the flexibility of elderly individuals before and after having practiced hatha yoga and calisthenics for 1 year (52 weeks), at least 3 times/week. Sixty-six subjects (12 men) measured and assigned to 3 groups: control (n = 24, age = 67.7±6.9 years), hatha yoga (n = 22, age = 61.2±4.8 years), and calisthenics (n = 20, age = 69.0±5.8 years). The maximal range of passive motion of 13 movements in 7 joints was assessed by the Flexitest, comparing the range obtained with standard charts representing each arc of movement on a discontinuous and non-dimensional scale from 0 to 4. Results of individual movements were summed to define 4 indexes (ankle+knee, hip+trunk, wrist+elbow, and shoulder) and total flexibility (Flexindex). Results showed significant increases of total flexibility in the hatha yoga group (by 22.5 points) and the calisthenics group (by 5.8 points) (p0.01 for each) and a decrease in the control group (by 2.1 points) (p0.01) after one year of intervention. Between-group comparison showed that increases in the hatha yoga group were greater than in the calisthenics group for most flexibility indexes, particularly the overall flexibility (p0.05). In conclusion, the practice of hatha yoga (i.e., slow/passive movements) was more effective in improving flexibility compared to calisthenics (i.e., fast/dynamic movements), but calisthenics was able to prevent flexibility losses observed in sedentary elderly subjects.

International audience; Objectives-To define guidelines for the management of women diagnosed with threatenedlate miscarriage (TLM).Materials and Methods-A systematic review of the literature was performed using Pubmedand the Cochrane library databases and the guidelines from main international societies.Results-Management of women diagnosed with threatened LM requires a complete history-taking searching for a previous history of LM and/or of premature delivery (Grade B). Speculumexamination is required to diagnose membrane prolapse (Grade B) and vaginal ultrasound scanis recommended to measure the cervical length (Grade B). Finally, initial management shouldallow to rule out chorioamniotitis (Grade B). Vaginal progesterone therapy (90-200 mg daily) isrecommended for women diagnosed with a sole shortened cervix (< 25 mm) in mid-pregnancy(Grade A). Cerclage is only recommended in women with both history of previous prematuredelivery and/or previous LM and shortened cervical length diagnosed before 24 weeks of ges-tation (Grade A). Finally, cervical cerclage (Mc Donald technique) associated with systematictocolytic therapy (indometacine) and antibiotics are to be recommended in women diagnosedwith TLM with dilated cervical os eventually associated with membrane prolapse (Grade C).