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Benhamou D, Tant S, Gille B, Bornemann Y, Ruscio L, Kamel K, Dunyach C, Jeannin B, Bouilliant-Linet M, Blanié A. An observer tool to enhance learning of incoming anesthesia residents' skills during simulation training of central venous catheter insertion: a randomized controlled trial. BMC Med Educ 2023; 23:942. [PMID: 38082446 PMCID: PMC10714635 DOI: 10.1186/s12909-023-04915-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Central venous catheter (CVC) insertion using simulation is an essential skill for anesthesiologists. Simulation training is an effective mean to master this skill. Given the large number of residents and the limited duration of training sessions, the active practice time is limited and residents remain observers of their colleagues for much of the session. To improve learning during observation periods, the use of an observer tool (OT) has been advocated but its educational effectiveness is not well defined. METHODS Incoming anesthesia residents were randomized to use an OT (i.e. procedural skill-based checklist) (OT+) or not (OT-) when observing other residents during a simulation bootcamp. The primary outcome was a composite score (total 60 points) evaluating CVC procedural skills rated immediately after the training. This score covers theoretical knowledge explored by multiple choice questions (MCQs) (/20), perceived improvement in knowledge and skills (/20), perceived impact on future professional life (/10) and satisfaction (/10). Measurements were repeated 1 month later. Residents in each group recorded the number of CVCs placed and their clinical outcomes (attempts, complications) during the first month of their clinical rotation using a logbook. RESULTS Immediately after training, the composite score was similar between the two groups: 45.3 ± 4.2 (OT+, n = 49) and 44.4 ± 4.8 (OT-, n = 42) (p = 0.323). Analysis of sub-items also showed no difference. Results at 1 month were not different between groups. Analysis of the logbook showed no difference between groups. No serious complications were reported. CONCLUSIONS The use of a procedural task-based OT by incoming anesthesia residents and used during CVC insertion simulation training was not associated with better learning outcomes, neither immediately after the session nor when re-evaluated 1 month later. The training at least once on simulator of all residents could limit the impact of OT. Further studies are necessary to define the place of OT in simulation training.
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Affiliation(s)
- Dan Benhamou
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
- CIAMS, Univ. Paris-Saclay, Université Paris-Saclay, Orsay Cedex, 91405, France
- CIAMS, Université d'Orléans, Orléans, 45067, France
| | - Sarah Tant
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Benoit Gille
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Yannis Bornemann
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Laura Ruscio
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Karl Kamel
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Chloé Dunyach
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Bénédicte Jeannin
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Maxime Bouilliant-Linet
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France
| | - Antonia Blanié
- Centre de simulation LabForSIMS, Département de Recherche et Innovation Pédagogique en Santé, Faculté de médecine Université Paris Saclay, Le Kremlin-Bicêtre, 94275, France.
- Département d'Anesthésie-Réanimation et Médecine Péri Opératoire, APHP, CHU Bicêtre, Le Kremlin Bicêtre, 94275, France.
- CIAMS, Univ. Paris-Saclay, Université Paris-Saclay, Orsay Cedex, 91405, France.
- CIAMS, Université d'Orléans, Orléans, 45067, France.
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Dépret F, Dunyach C, De Tymowski C, Chaussard M, Bataille A, Ferry A, Moreno N, Cupaciu A, Soussi S, Benyamina M, Mebazaa A, Serror K, Chaouat M, Garnier JP, Pirracchio R, Legrand M. Undetectable haptoglobin is associated with major adverse kidney events in critically ill burn patients. Crit Care 2017; 21:245. [PMID: 28946897 PMCID: PMC5613314 DOI: 10.1186/s13054-017-1837-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/07/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Intravascular haemolysis has been associated with acute kidney injury (AKI) in different clinical settings (cardiac surgery, sickle cell disease). Haemolysis occurs frequently in critically ill burn patients. The aim of this study was to assess the predictive value of haptoglobin at admission to predict major adverse kidney events (MAKE) and AKI in critically ill burn patients. METHODS We conducted a retrospective, single-centre cohort study in a burn critical care unit in a tertiary centre, including all consecutive severely burned patients (total burned body surface > 20% and/or shock and/or mechanical ventilation at admission) from January 2012 to April 2017 with a plasmatic haptoglobin dosage at admission. RESULTS A total of 130 patients were included in the analysis. Their mean age was 49 (34-62) years, their median total body surface area burned was 29% (15-51%) and the intensive care unit (ICU) mortality was 25%. Early haemolysis was defined as an undetectable plasmatic haptoglobin at admission. We used logistic regression to identify MAKE and AKI risk factors. In multivariate analysis, undetectable haptoglobin was associated with MAKE and AKI (respectively, OR 6.33, 95% CI 2.34-16.45, p < 0.001; OR 8.32, 95% CI 2.86-26.40, p < 0.001). CONCLUSIONS Undetectable plasmatic haptoglobin at ICU admission is an independent risk factor for MAKE and AKI in critically ill burn patients. This study provides a rationale for biomarker-guided therapy using haptoglobin in critically ill burn patients.
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Affiliation(s)
- François Dépret
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Paris, France
| | - Chloé Dunyach
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France
| | - Christian De Tymowski
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France
| | - Maïté Chaussard
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Paris, France
| | - Aurélien Bataille
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Paris, France
| | - Axelle Ferry
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Paris, France
| | - Nabila Moreno
- Service de Biochimie, Hôpital universitaire St-Louis, 1 avenue Claude Vellefaux, Paris, 75010, France
| | - Alexandru Cupaciu
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Paris, France
| | - Sabri Soussi
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Paris, France
| | - Mourad Benyamina
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Paris, France.,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), French Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (INI-CRCT network), Paris, France.,French Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (INI-CRCT network), Paris, France
| | - Kevin Serror
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Paris, France
| | - Marc Chaouat
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Paris, France
| | - Jean-Pierre Garnier
- Service de Biochimie, Hôpital universitaire St-Louis, 1 avenue Claude Vellefaux, Paris, 75010, France
| | - Romain Pirracchio
- Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris, 75015, France.,Service de Biostatistique et Informatique Médicale, INSERM UMR-1153, Equipe ECSTRA, Hôpital Saint Louis, Sorbonne Paris Cité, Paris, France
| | - Matthieu Legrand
- Department of Anesthesiology and Critical Care and Burn Unit, Groupe Hospitalier St-Louis-Lariboisière, Assistance publique - Hôpitaux de Paris, Paris, France. .,Université Paris Diderot, Paris, France. .,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), French Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (INI-CRCT network), Paris, France. .,French Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (INI-CRCT network), Paris, France.
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Drakulovski P, Dunyach C, Bertout S, Reynes J, Mallié M. A Candida albicans strain with high MIC for caspofungin and no FKS1 mutations exhibits a high chitin content and mutations in two chitinase genes. Med Mycol 2010; 49:467-74. [PMID: 21108572 DOI: 10.3109/13693786.2010.538732] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We studied the cell wall of a Candida albicans laboratory mutant exhibiting a high minimum inhibitory concentration (MIC; 8 μg ml(-1)) for caspofungin without bearing FKS1 mutations. This strain showed a reduced level of ß 1,3 D glucan (0.43×) and a higher chitin content (2.3×) than a control strain even when grown without caspofungin. No significant over- or under-expression of chitin synthase or chitinase genes was observed. However, point mutations were detected in the chitinase 2 and 3 genes. These mutations, which may affect the enzymatic activity of the encoded protein products involved in the degradation of the chitin, could have led to an increased concentration of that component, allowing the strain to compensate for its low ß 1,3 D glucan content and the effect of caspofungin.
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Affiliation(s)
- P Drakulovski
- UMR 145 IRD/UM1: VIH/SIDA et Maladies Associées, UFR des Sciences Pharmaceutiques et Biologiques, Montpellier Cedex, France
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Bertout S, Dunyach C, Drakulovski P, Reynes J, Mallié M. Comparison of the Sensititre YeastOne® dilution method with the Clinical Laboratory Standards Institute (CLSI) M27-A3 microbroth dilution reference method for determining MIC of eight antifungal agents on 102 yeast strains. ACTA ACUST UNITED AC 2010; 59:48-51. [PMID: 20843616 DOI: 10.1016/j.patbio.2010.07.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 07/30/2010] [Indexed: 11/29/2022]
Abstract
The Clinical Laboratory Standards Institute ([CLSI] formerly NCCLS) reference broth microdilution testing method (protocol M27-A3) was compared with a commercially available methods (Sensititre YeastOne(®)) by testing two quality control strains and 102 isolates of Candida sp. and Cryptococcus sp. against fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole, flucytosin, amphotericin B and caspofungin. Minimal inhibitory concentrations (MIC) endpoints were determined after 24h of incubation for Sensititre YeastOne(®) and after 24 and 48 h for CLSI microdilution method. Essential agreements between methods vary from 70.6 to 92.2%. Categorical agreements vary from 94.1% for 5FC to 72.6% for AMB. Sensititre YeastOne(®) reading appears to be useful for avoiding very major errors and this confirms the interest of this method for evaluating new antifungals activity in vitro.
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Affiliation(s)
- S Bertout
- UMR 145 (IRD/UM1), UFR sciences pharmaceutiques et biologiques, 15, avenue Charles-Flahault, BP 14491, 34093 Montpellier cedex 5, France
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