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Management of renal replacement therapy among adults in French intensive care units: A bedside practice evaluation

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Journal of Intensive Medicine 2023年第2期3卷 147-154页

作者： Florian Jolly Marine Jacquier Delphine Pecqueur Marie Labruyère Christophe Vinsonneau Isabelle Fournel Jean-Pierre Quenot The READIAL Study group Service de Médecine Intensive-Réanimation CHU Dijon-BourgogneDijon 21000France Equipe Lipness Centre de recherche INSERM UMR1231 et LabEx LipSTICUniversitéde Bourgogne-Franche ComtéDijon 21000France INSERM CIC 1432Module Epidémiologie CliniqueDijon 21000France CHU Dijon-Bourgogne Centre d’Investigation CliniqueModule Epidémiologie Clinique/Essais CliniquesDijon 21000France Service de Médecine Intensive Réanimation-Unitéde Sevrage Ventilatoire et Réhabilitation CH de BethuneBethune 62408France 不详

Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the ***:A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, ***:Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.

关键词： Renal replacement therapy Acute kidney injury Intensive care unit Practice evaluation bedside

Spontaneous bacterial peritonitis:risk factors and causative organisms

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Asian Pacific Journal of Tropical Medicine 2009年第6期2卷 52-58页

作者： Mahmoud M Al-Bendary Mahmoud Abdel-Aziz Waleed A Al-Sherbeeny Raghda El-Sayed Farag Abdel-Hady El-Gilany Mohammad Hosam Eldeen Zaghloul Tropical Medicine Unit Community Medicine DepartmentCollege of MedicineMansoura UniversityEgypt Clinical Pathology Department College of MedicineMansoura UniversityEgypt

Objective:To determine the prevalent pathogens responsible for spontaneous bacterial peritonitis(SBP) and their sensitivity pattern,to test the efficiency of different culture techniques in microbial isolation,and to study the diagnostic predictors of such ***:One hundred eight SBP episodes from 92 adult patients were compared to 88 cirrhotic ascites patients cross - matched with age and sex without *** fluid was subjected to cytological,biochemical examination and culture on both conventional and blood culture bottles at the bedside for bacterial identification and antimicrobial susceptibility ***:The prevalence of SBP was 25.02%.Logistic regression analysis revealed that;previous SBP episode,low ascitic fluid protein levels, high serum creatinine and low serum albumin levels were the independent significant predictors of *** forty - five per cent of SBP episodes were detected by conventional culture compared to 73.15%by modified technique with a significant *** - negative bacteria were the cause of SBP in 46(58.23%) culture positive *** coli and Staphylococcus aureus were the most commonly detected organisms. Resistance to different antibiotics was ***:Culture of ascitic fluid in blood culture bottles at bedside increases the sensitivity of SBP *** is a recent increase in Gram - positive pathogen with emergence of multidrug *** recent changes may have an impact on guidelines for management and treatment of SBP in our locality.

关键词： Spontaneous bacterial peritonitis Paracentesis bedside inoculation Blood bottle culture

Role of endoscopy in acute gastrointestinal bleeding in real clinical practice:An evidence-based review

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World Journal of Gastrointestinal Endoscopy 2019年第2期11卷 68-83页

作者： Kyoungwon Jung Won Moon Department of Internal Medicine Kosin University College of Medicine

Although upper gastrointestinal bleeding is usually segregated from lower gastrointestinal bleeding, and guidelines for gastrointestinal bleeding are divided into two separate sections, they may not be distinguished from each other in clinical practice. Most patients are first observed with signs of bleeding such as hematemesis, melena, and hematochezia. When a patient with these symptoms presents to the emergency room, endoscopic diagnosis and treatment are considered together with appropriate initial resuscitation. Especially, in cases of variceal bleeding, it is important for the prognosis that the endoscopy is performed immediately after the patient stabilizes. In cases of suspected lower gastrointestinal bleeding, full colonoscopy after bowel preparation is effective in distinguishing the cause of the bleeding and treating with hemostasis. The therapeutic aspect of endoscopy, using the mechanical method alone or injection with a certain modality rather than injection alone, can increase the success rate of bleeding control. Therefore, it is important to consider the origin of bleeding and how to approach it. In this article, we aim to review the role of endoscopy in diagnosis, treatment, and prognosis in patients with acute gastrointestinal bleeding in a real clinical setting.

关键词： Endoscopy Gastrointestinal bleeding Endoscopic bleeding control Emergency bowel preparation bedside endoscopy Second-look endoscopy

Practical strategies for increasing efficiency and effectiveness in critical care education

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World Journal of Critical Care Medicine 2017年第1期6卷 1-12页

作者： Maurice F Joyce Sheri Berg Edward A Bittner Department of Anesthesia Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School

Technological advances and evolving demands inmedical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.

关键词： Medical education Critical care Educational efficiency Educational efficacy bedside teaching Flipped classroom Patient handover Multidisciplinary team practice In situ simulation Procedural training

Translational medical mycology guides clinical and laboratory practice on fungal diseases

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World Journal of Translational Medicine 2014年第1期3卷 31-36页

作者： Jebina Lama Xin Ran Yu-Ping Ran Department of Dermatovenerology West China Hospital of Sichuan University Department of Dermatology and Rheumatology The Second Affiliated Hospital of Kunming Medical University

Patients with fungal infection having skin lesions may consult a dermatologist, which is a diagnostic and therapeutic challenge. Dermatologists take samples from the lesion to check the fungal elements under a microscope by KOH preparation and then treat the patient. This model has advanced from bedside to bench and from bench to bedside(B to B to B), which is defined as Translational Medical Mycology. Dermatologists have an advantageous position in finding, isolating and identifying the pathogenic fungi and treating the patient with antifungal drugs. Samples should be cultured in different media with or without chloramphenicol and cycloheximide and incubated at room temperature or 37 ℃. Non-culture techniques such as polymerase chain reaction based molecular identification, transmission electron microscopy, scanning electron microscopy, biochemistry tests and histopathology are also necessary to confirm the identification of the species, especially when the routine culture is negative. We start treatment upon obtaining evidence of fungal infection,i.e., positive KOH examination. Antifungal drugs such as itraconazole, fluconazole, terbinafine and amphotericin B can be used alone or in combination based on the fungal species and the location of the lesion. Practice on fungal infection includes screening of the patient, merging all of the laboratory techniques and methods from the microbiologists, pathologists, molecular researchers, identification of the pathogen and determination of the optimum antifungal drug.

关键词： Translational Mycology bedside Bench Fungal infections

Approaches to Improving Nursing Handoffs in Surgical Wards

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Open Journal of Nursing 2017年第9期7卷 1034-1043页

作者： Katherine S. Blondon Frederic Ehrler Sandrine Le Godais Jean-Yves Wojtasikiewicz Charline Couderc Medical Directorate University Hospitals of Geneva Geneva Switzerland Division of Medical Information Science University Hospitals of Geneva Geneva Switzerland Department of Surgery University Hospitals of Geneva Geneva Switzerland

Objective: To propose approaches to improve nursing handoffs for surgical patients, including standardization. Background: Handoffs, or the transfer of accountability and patient information, can generate potential risks for patient safety. Standardization has been proposed to help improve handoffs. Methods: After observing 333 nursing handoffs in the surgical wards of our institution, we conducted a thematic content analysis, comparing and contrasting the observations. Results: Handoff processes, including the use of support tools, varied among the observations. Common themes in the handoff content suggested possibilities of standardization. About half of the 51 interruptions occurring during the observed handoffs were by healthcare professionals. Conclusions: Standardization to improve handoffs should address both the content and the process. Interruptions were common and should be avoided whenever possible. Future studies should also consider the use of mobile applications to support handoffs and clinical documentation.

关键词： Nursing Handoffs Handover Nursing Sign-Out Shift Report bedside Handoff