Groupe Hospitalier du Havre

Background: Surgery ward caregivers are responsible for educating patients about the pre-operative shower (POS), assisting with the shower as necessary, and evaluating skin cleanliness prior to transport to the operating theater to mitigate the risk of surgical site infections.Aim: To describe the knowledge, attitudes, and declared practices of surgery ward caregivers concerning the POS.Methods: A multi-center prospective survey was performed on a random sample of nurses and nurses' assistants from five French surgical facilities. Caregivers were asked about their training regarding POS, their ward protocol, knowledge of current French guidelines, attitudes, self-reported practices, and challenges pertaining to the POS.Results: All selected caregivers agreed to participate. Of the 72 respondents, 39% declared having received POS-related initial training, whereas 49% indicated the presence of a POS protocol within their ward. Both nurses and nurses' assistants reported a lack of clear delineation in their tasks regarding the POS. Knowledge of the existing POS guidelines was found suboptimal, with superfluous precautions wrongly deemed mandatory. As regards personal practices, caregivers highlighted the need to tailor communication to the patient's age, dependence, and body size. The predominant declared method for assessing skin cleanliness was verification of POS completion, occasionally supplemented by visual inspection of the incision site. Skin cleanliness assessment was poorly organized and perceived as intrusive by caregivers, especially for surgeries involving genital areas, with the patient's gender markedly impacting this perception.Discussion: This survey corroborates substantial deficiencies in POS process training, implementation, and caregiver perceptions.

To evaluate the impact of the AirSeal® insufflation system on postoperative pain, analgesic consumption, and patient satisfaction following robot-assisted radical prostatectomy (RARP), using real-world patient-reported outcomes (PROMs) collected via a digital health platform. This retrospective multicenter study included 312 patients undergoing RARP for localized prostate cancer across 19 French centers (September 2024-June 2025). Forty-seven patients (15.1%) underwent RARP with AirSeal® (low or standard pressure) and 265 (84.9%) with conventional insufflation (standard pressure). Pain scores, measured using the Visual Analogue Scale and analgesic use were recorded daily from postoperative day (POD) 1-14 via the CE-certified Betty Coaching smartphone application. Secondary outcomes included length of stay, sick leave duration, patient satisfaction at 6 weeks, and postoperative complications. Baseline characteristics were comparable between groups. Median pain scores were consistently lower with AirSeal®, with complete pain resolution by POD8 versus POD14 for conventional insufflation. By POD8, all AirSeal® patients were analgesic-free, compared to 83% at POD14 in the control group. All patients were opioid-free within 2 weeks. Hospital stay (median 1day) and satisfaction (median score 10/10) were similar. Complication rates (10.6% vs. 6.8%, p = 0.352) and readmissions did not differ significantly. Use of the AirSeal® system in RARP was associated with faster pain resolution and earlier cessation of analgesics without compromising perioperative safety. Digital PROMs collection via the Betty Coaching platform offers precise recovery monitoring, reinforcing its role in enhanced recovery pathways and supporting the integration of valveless insufflation technology into minimally invasive urologic surgery.

BackgroundPost-extubation stridor is a common complication of endotracheal intubation in ICU. This study aimed to assess whether a series of pre-extubation upper airway ultrasound measurements using shear wave elastography (SWE) could help in detecting post-extubation stridor.MethodsA prospective observational study (NCT05611437) was conducted between 2022 and 2024, which consecutively included 150 adults ICU patients intubated for more than 24 h, without prior surgical or neurological upper airway disease nor swallowing disorders. SWE measurements were performed in the 24 h before extubation. The occurrence of post-extubation stridor, dysphonia and swallowing disorders were assessed within 72 h.Results125 participants were included in the final analysis. A total of 2,625 ultrasound images were obtained, with 81% deemed interpretable. Post-extubation stridor occurred in 9% of patients and was independently associated with sepsis at admission (OR 8.98; 95%CI 1.3–62.1). No differences were observed between upper airway ultrasound in patients with or without stridor. Stridor was associated with higher rates of dysphonia (82% vs. 23%), swallowing disorders (36% vs. 11%), and extubation failure (46% vs. 10%). Swallowing disorders were independently associated with the duration of mechanical ventilation (OR 1.10; 95% CI 1.04–1.17). Dysphonia was associated with female sex (OR 3.23; 95%CI 1.24–8.37), sternothyroid muscle stiffness (OR 1.11; 95%CI 1.04–1.18), and days of mechanical ventilation (OR 1.09; 95%CI 1.02–1.15).ConclusionOropharyngeal SWE is feasible in critically ill patients before extubation, but was not predictive of post-extubation stridor. Further studies are needed to explore its role in predicting post-extubation upper airway complications.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13054-025-05659-2.

In patients with venous thromboembolism at high risk of recurrence for whom extended treatment with direct oral anticoagulants has been indicated, the optimal dose is unknown. We aimed to assess efficacy and safety of reduced-dose versus full-dose direct oral anticoagulants in patients in whom extended anticoagulation has been indicated. RENOVE was a non-inferiority, investigator-initiated, multicentre, randomised, open-label, blinded endpoint trial done in 47 hospitals in France. Ambulatory patients aged 18 years or older with acute symptomatic venous thromboembolism (pulmonary embolism or proximal deep vein thrombosis) who had received 6-24 uninterrupted months of full-dose anticoagulation and for whom extended anticoagulation has been indicated were eligible. Eligible participants were categorised as having either a first unprovoked venous thromboembolism, recurrent venous thromboembolism, presence of persistent risk factors, or other clinical situations considered to be a high risk of recurrence. Participants were randomly assigned (1:1) to receive oral treatment with either a reduced dose of apixaban (2·5 mg twice daily) or rivaroxaban (10 mg once daily) or a full dose of apixaban (5 mg twice daily) or rivaroxaban (20 mg once daily) using a centralised randomisation procedure with an interactive web response system. The sequence generation method was a computerised random number generator and was balanced by blocks of different sizes. Randomisation was stratified by centre, type of direct oral anticoagulant, and antiplatelet drug. Physicians and participants were unmasked to treatment allocation; recurrent venous thromboembolism, clinically relevant bleeding, and all-cause death were adjudicated by an independent committee blinded to treatment allocation. The primary outcome was symptomatic recurrent venous thromboembolism, including recurrent fatal or non-fatal pulmonary embolism or isolated proximal deep vein thrombosis (non-inferiority hypothesis 90% power to exclude a hazard ratio [HR] of 1·7). The primary outcome and first two secondary outcomes were included in a hierarchical testing procedure. This trial is registered with ClinicalTrials.gov, NCT03285438. From Nov 2, 2017, to July 6, 2022, 2768 patients were enrolled and randomly assigned to the reduced-dose group (n=1383) or the full-dose group (n=1385). 970 (35·0%) participants were female, 1797 (65·0%) were male, and one (<0·1%) had sex not reported. Median follow-up was 37·1 months (IQR 24·0-48·3). Recurrent venous thromboembolism occurred in 19 of 1383 patients in the reduced-dose group (5-year cumulative incidence 2·2% [95% CI 1·1-3·3]) versus 15 of 1385 patients in the full-dose group (5-year cumulative incidence 1·8% [0·8-2·7]; adjusted HR 1·32 [95% CI 0·67-2·60]; absolute difference 0·40% [95% CI -1·05 to 1·85]; p=0·23 for non-inferiority). Major or clinically relevant bleeding occurred in 96 patients in the reduced-dose group (5-year cumulative incidence 9·9% [95% CI 7·7-12·1]) and 154 patients in the full-dose group (5-year cumulative incidence 15·2% [12·8-17·6]; adjusted HR 0·61 [95% CI 0·48-0·79]). 1136 (82·1%) of 1383 patients in the reduced-dose group and 1150 (83·0%) of 1385 in the full-dose group had an adverse event; 374 (27·0%) patients in the reduced-dose group and 420 (30·3%) in the full-dose group has a serious adverse event. 35 (5-year cumulative incidence 4·3% [95% CI 2·6-6·0]) patients in the reduced-dose group and 54 (5-year cumulative incidence 6·1% [4·3-8·0]) patients in the full-dose group died during the study period. In patients with venous thromboembolism requiring extended anticoagulation, reduction of the direct oral anticoagulant dose did not meet the non-inferiority criteria. However, the low recurrence rates in both groups and substantial reduction of clinically relevant bleeding with the reduced dose could support this regimen as an option. Further research will be needed to identify subgroups for whom the anticoagulation dose should not be reduced. French Ministry of Health.

Melioidosis, caused by the Gram-negative bacillus Burkholderia pseudomallei, is increasingly recognised as a threat beyond its endemic regions of Southeast Asia and Northern Australia. Globalisation, international travel, and environmental change have facilitated its emergence in Western countries, where it remains underdiagnosed due to limited clinical awareness and microbiological preparedness. We report a case of imported melioidosis in a 52-year-old French male who returned from Thailand with an initial pulmonary presentation, followed by central nervous system involvement manifesting as focal pachymeningitis. Diagnostic efforts were hindered by the pathogen’s misidentification via MALDI-TOF mass spectrometry, due to biosecurity-related database restrictions excluding B. pseudomallei. Accurate diagnosis was achieved only after relapse and referral to a national reference laboratory. This case underscores the diagnostic and therapeutic challenges posed by tropical pathogens in non-endemic settings and the need to adapt clinical protocols, microbiological platforms, and physician training in Western healthcare systems. The emergence of such infections highlights the shifting landscape of global health, shaped by travel, climate change, and evolving microbial ecologies. Greater vigilance is warranted to prevent delayed diagnoses and optimise management of imported and emerging infectious diseases.