Prognostic factors influencing the outcome of empyema surgical management: prospective study in a Moroccan university center.

Background: Pleural empyema is a public health problem, and is the most frequent complication of pleural infection with significant morbidity and mortality worldwide. Our study aims to highlight the management of pleural empyema and evaluate its prognosis factors involved especially in surgical treatment. Patients and Methods: A prospective analysis of 53 patients who underwent surgical treatment of pleural empyema, from January 2015 to December 2019 at the thoracic surgery department in a tertiary referral university teaching hospital. Our study included patients who required surgical treatment for pleural empyema and were excluded patients with destroyed lungs associated with pyothorax. Results: The mean age of patients was 39.24±15.89 years and 79,24% of them were males. In 85.7% of the cases, the etiology was undetermined in 34%, parapneumonic in 1.9%, of tuberculosis in 54.71%, post-traumatic in 11, 3%, postoperative in 7.5% and iatrogenic in 1.9%. 45 patients were treated with broad-spectrum antibiotics therapy adapted after antibiogram 14.38±21.76 days before the operation. A complete debridement and decortications were performed by VATS in 28 and by PLT in 22 patients. No major complications occurred. At a mean term follow-up of 20 months (3months—3 years); all patients were alive with no recurrence. The analysis of the results showed 4 factors of poor prognosis: delay of diagnosis and surgery (P = 0.02), chronic alcoholism (P = 0.034), preoperative ventilation disorder/COPD (P = 0.04) and active tuberculosis (P= 0, 05). Conclusion: The success of surgical management of pleural empyema depends on several factors, which predict the prognosis, but can be prevented.

Experiences of Motherhood in University Students in Brazil: A Qualitative Study

Introduction: The women’s rise to higher education contrasts with the phenomenon of motherhood, since it instigates changes in various contexts, whether physiological or emotional, and directly affects the way of life and routine of those women, resulting in a constant conflict between motherhood and academic career. In this sense, the student has to restructure responsibilities and behaviors, as well as requires family support and laws that support her in this period. Objectives: To describe the experiences of motherhood in university students, and to identify the strategies developed by university students to adapt motherhood with academic routine. Methods: This is a descriptive, exploratory and qualitative research carried out in a private University Center in Brazil. The participants were ten Nursing undergraduate students, regularly enrolled and who experienced motherhood during the academic term. Data were collected during August and September 2019, through a recorded interview using a semi-structured form. For the treatment and analysis of the data, the Collective Subject Discourse was used. The study followed the ethical precepts and was approved by the ethics committee (opinion n. 3.419.572). Results: The participants’ discourses gave rise to four central ideas: Feelings experienced from the discovery of pregnancy; The discovery of pregnancy and the decision to continue the course; Support relationships as a decisive factor for the non-abandonment of the course and Strategies to reconcile motherhood with academic routine. The main key expressions identified in the discourses were: joy, fear, insecurity, anguish, concern, distress, anger, sadness, interrupting, giving up, taking time off from the course, not taking time off from the course, family support, support from friends, support from the institution, adjusting schedules, studying while my child sleeps, family help, taking the baby to college, storing milk while breastfeeding. Conclusion: The analysis of the discourses revealed that the experience of motherhood in the university sphere is marked by a combination of different feelings, and by an important process of adaptations to the new moment, since there is a reflection and indecision about the continuity of the academic trajectory. The reports also highlight the importance of family, institutional and friend support, such as a support network of incentive to the care with the child, as well as the use of strategies to reconcile academic routine with motherhood.

Medical Facilities for Refugees in Europe: Creating a Consultation for Resettled Syrian Families

The wave of migration that has hit Europe in recent years has led to several changes in the organization of asylum systems and medical care provided to migrants. Previous studies indicate that asylum seekers and refugees face multiple barriers in accessing health care. For that reason, adapted structures are needed. In this context, a family consultation service was implemented in our medical center in Lausanne, Switzerland. It aimed at addressing the unique health care needs of recently resettled families from Syria, which has been the leading source country for refugees since 2014. This intervention, developed through collaboration between the University Center for Primary Care and Public Health (Unisanté) and the Children's Hospital of Lausanne (HEL) involved a multidisciplinary team comprising a pediatrician, a general practitioner and a pediatric nurse. Bringing together a multidisciplinary team optimized care coordination, facilitated communication between care providers and enabled a more global vision of the family system with the aim of enhancing quality of care.