Durée de traitement des pyélonéphrites aiguës communautaires non compliquées de la femme jeune ( Etude épidémiologique et premiers résultats de l'essai DTP)

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Setting Conditions for Productive Debriefing

Background. Debriefing is a fundamental step in simulation, particularly in the medical field. Simulation sometimes even serves as a pretext for debriefing. Most often, debriefing takes place easily, producing a qualitative feedback and an optimal learning transfer. But sometimes, the facilitator faces difficulties. An unproductive debriefing can be described as follows: the debriefing of a clinical simulation session is unproductive when facilitators or learners perceive the occurrence of an obstacle that has hindered the learning process. Objectives & method. Considering the difficulties encountered in this type of debriefing, we believe it is necessary to investigate the topic in depth in order to bring out some theoretical principles. Based on a Nominal Group Technique involving the authors of this article, this project aimed at drawing up and proposing informed recommendations for ensuring productive debriefing in simulation-based education in healthcare. Results. The authors make the following recommendations: Reflect on your own performances as an instructor (asking for feedback from the learners and peers, and being appropriately trained as an instructor who can facilitate learning) Establish simulation ground rules (preparing and briefing the learners before the simulation experience, controlling the timing of the simulation session and the quality of the scenarios) Manage unexpected events and intended learning objectives by using a confederate during scenarios. Respect the steps of the debriefing process and good practice recommendations regarding learning psychology. Maintain the balance between emotion and teaching by decontextualizing the experience from the participants during the debriefing. Manage the input from the peers during the debriefing so they do not antagonise the learning process. Reflect on your own performances as an instructor (asking for feedback from the learners and peers, and being appropriately trained as an instructor who can facilitate learning) Establish simulation ground rules (preparing and briefing the learners before the simulation experience, controlling the timing of the simulation session and the quality of the scenarios) Manage unexpected events and intended learning objectives by using a confederate during scenarios. Respect the steps of the debriefing process and good practice recommendations regarding learning psychology. Maintain the balance between emotion and teaching by decontextualizing the experience from the participants during the debriefing. Manage the input from the peers during the debriefing so they do not antagonise the learning process. Conclusion. Six key recommendations are proposed. They have been deemed as core skills required of every simulation facilitator to prepare for productive debriefing and so the set learning objectives of a simulation session can be achieved successfully.Peer reviewedFinal Accepted Versio

Analyse du réseau de santé en gériatrie aiguë au service d'accueil des Urgences du centre Hospitalo-Universitaire Cochin

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Effect of combined individual-collective debriefing of participants in interprofessional simulation courses on crisis resource management: a randomized controlled multicenter trial.

International audienceInterprofessional simulation (IPS) training is an effective way to learn crisis resource management. The type of debriefing used in IPS training may affect participants' performance and their level of psychological safety. We aimed to assess and compare performance after standard collective debriefing versus a combination of individual and collective debriefing ("combined" approach)

Designing simulation-based curriculum content for emergency medicine residents in France: a Delphi method

International audienceBackground: The value of simulation in emergency medicine is indisputable because it allows training and acquisition of many technical and non-technical skills (TS and NTS). In France, there are no curriculum regarding the use of simulation as a teaching tool during emergency medicine residency. The aim of this study was to design the content of a national simulationbased curriculum for emergency medicine residency programs. Methods: : The Delphi method was conducted between March and June 2022. The questionnaire was divided into three sections: TS, NTS and clinical situations as starting points (SSPs). A panel of emergency physicians' experts on simulation education was established. An online survey was conducted in which they were asked to score, on a fourpoint Likert scale, the suitability of skills and SSPs to be taught through simulation courses during the emergency medicine residency. The questionnaire was revised between each round following comments or suggestions for additional items from the experts. Results: Sixty-six experts completed the Delphi process. The initial questionnaire included 64 TS, 37 NTS and 103 SSPs. The experts' comments led to the addition of 12 TS, 24 NTS and 6 SSPs. Consensus was obtained after three rounds. The experts selected 24 TS and 20 NTS to be taught as a priority through simulation during the emergency medicine residency, and 15 SSPs to be used in priority. Conclusion: With a Delphi method, French experts in simulation-based emergency medicine education have selected 24 technical and 20 non-technical skills to be taught as a priority with simulation-based training to emergency medicine residents.</div

Plasmatic presepsin (sCD14-ST) concentrations in acute pyelonephritis in adult patients

International audienceINTRODUCTION:Presepsin (sCD14-ST) is an emerging biomarker for infection. We hypothesized that presepsin could specifically increase during acute pyelonephritis and correlate with severity.METHODS:We compared presepsin values in patients with acute pyelonephritis and controls, and we assessed its capacity to predict bacteraemia and admission in patients.RESULTS:In 312 patients with acute pyelonephritis (median age 33years), presepsin concentrations were higher than in controls (476 vs 200ng/L, p<0.001). ROC curve indicated an AUC at 0.90 [for presepsin (vs. 0.99 and 0.98 for CRP and PCT, respectively; p<0.05) and an optimal threshold at 340ng/L (74% sensitivity, 94% specificity). Presepsin concentrations increased in acute pyelonephritis patients with bacteraemia (614 vs. 461ng/L, p,=0.001) and in those requiring admission (614ng/L vs. 320ng/L, p<0.001). Performance of presepsin to predict bacteraemia [AUC=0.63, 95%CI: 0.55-0.72] was similar to CRP (AUC=0.64, p=0.87) and less accurate than PCT (AUC=0.78, p<0.001). AUC for presepsin to detect the need for admission was 0.67, and comparable to CRP (p=0.26) and PCT (p=0.18).CONCLUSION:Presepsin is a valuable biomarker to detect patients with acute pyelonephritis. However, it presents mild performance to predict bacteraemia and the need for admission, and offers no advantage as compared to CRP and PCT

The 2024 French guidelines for scenario design in simulation-based education: manikin-based immersive simulation, simulated participant-based immersive simulation and procedural simulation.

peer reviewed[en] BACKGROUND: Simulation-based education in healthcare encompasses a wide array of modalities aimed at providing realistic clinical experiences supported by meticulously designed scenarios. The French-speaking Society for Simulation in Healthcare (SoFraSimS) has developed guidelines to assist educators in the design of scenarios for manikin- or simulated participant- based immersive simulation and procedural simulation, the three mainly used modalities. METHODS: After establishing a French-speaking group of experts within the SoFraSimS network, we performed an extensive literature review with theory-informed practices and personal experiences. We used this approach identify the essential criteria for practice-based scenario design within the three simulation modalities. RESULTS: We present three comprehensive templates for creating innovative scenarios and simulation sessions, each tailored to the specific characteristics of a simulation modality. The SoFraSimS templates include five sections distributed between the three modalities. The first section contextualizes the scenario by describing the practicalities of the setting, the instructors and learners, and its connection to the educational program. The second section outlines the learning objectives. The third lists all the elements necessary during the preparation phase, describing the educational method used for procedural simulation (such as demonstration, discovery, mastery learning, and deliberate practice). The fourth section addresses the simulation phase, detailing the behaviors the instructor aims to analyze, the embedded triggers, and the anticipated impact on simulation proceedings (natural feedback). This ensures maximum control over the learning experience. Finally, the fifth section compiles elements for post-simulation modifications to enhance future iterations. CONCLUSION: We trust that these guidelines will prove valuable to educators seeking to implement simulation-based education and contribute to the standardization of scenarios for healthcare students and professionals. This standardization aims to facilitate communication, comparison of practices and collaboration across different learning and healthcare institutions.‘What this article adds’1. The SoFraSimS provides guidelines to facilitate the development of simulation-based activities.2. These guidelines are theory-informed as well as evidence and experience-based.3. A detailed approach to writing a complete activity or scenario for procedural and immersive simulation including manikins or simulated participants is provided (the ‘SoFraSimS templates’).4. This work aims at standardizing practices and exchanging scenarios between simulation centers

Effectiveness of a Multifaceted Informational-Based and Text Message Reminders on Pneumococcal and Influenza Vaccinations in Hospital Emergency Departments: A Cluster-Randomized Controlled Trial

International audienceObjectives. We aimed to evaluate the effectiveness of a multifaceted procedure in improving pneumococcal and influenza vaccinations 6 months after an emergency department (ED) visit among patients aged 65 years and older. Methods. We conducted a cluster-randomized, controlled, parallel-group, open-label implementation trial in 18 EDs in France and Monaco. Participants were recruited from November 2015 to September 2016. EDs were randomly assigned with a 1:1 ratio to provide either a multifaceted procedure that combined structured information about pneumococcal and influenza vaccines and three text message reminders sent to patients every two weeks (intervention arm) or nonstructured information only (control arm). The outcomes were self-reported pneumococcal vaccination and influenza vaccination rates within 6 months of enrollment. Results. A total of 9 EDs were randomized to the intervention arm (n = 780 patients) and 9 to the control arm (n = 695 patients). The median age for all enrolled patients was 74 years (25–75th percentiles, 69 to 82): 50.1% were male, 34.9% had at least one underlying condition, and 30.7% were at risk for invasive pneumococcal infection. In the intention-to-treat analysis, the multifaceted intervention did not alter the pneumococcal vaccination rate (6.4% versus 4.6%, absolute difference: 1.8; 95% CI: [−0.9 to 4.4]; p = 0.19), whereas it improved the influenza vaccination rate (52.1% versus 40.0%, absolute difference: 12.1; 95% CI: [2.4 to 21.8]; p = 0.01). At 12 months, mortality did not differ between the intervention (9.7%) and control (11.2%) arms (p = 0.35). Conclusions. A multifaceted intervention based on text message reminders provides an opportunity to increase anti-influenza vaccination among elderly patients visiting the ED. Efforts are warranted to provide better information on pneumococcal diseases and the benefits of pneumococcal vaccines, especially in the elderly

Clevidipine in acute heart failure: results of the A study of blood pressure control in acute heart failure - a pilot study (PRONTO)

Background Rapid blood pressure (BP) control improves dyspnea in hypertensive acute heart failure (AHF). Although effective antihypertensives, calcium-channel blockers are poorly studied in AHF. Clevidipine is a rapidly acting, arterial selective intravenous calcium-channel blocker. Our purpose was to determine the efficacy and safety of clevidipine vs standardof- care intravenous antihypertensive therapy (SOC) in hypertensive AHF.Methods This is a randomized, open-label, active control study of clevidipine vs SOC in emergency department patients with AHF having systolic BP >= 160 mm Hg and dyspnea >= 50 on a 100-mm visual analog scale (VAS). Coprimary end points were median time to, and percent attaining, a systolic BP within a prespecified target BP range (TBPR) at 30 minutes. Dyspnea reduction was the main secondary end point.Results Of 104 patients (mean [SD] age 61 [14.9] years, 52% female, 80% African American), 51 received clevidipine and 53 received SOC. Baseline mean (SD) systolic BP and VAS dyspnea were 186.5 (23.4) mm Hg and 64.8 (19.6) mm. More clevidipine patients (71%) reached TBPR than did those receiving SOC (37%; P =.002), and clevidipine was faster to TBPR (P =.0006). At 45 minutes, clevidipine patients had greater mean (SD) VAS dyspnea improvement than did SOC patients (-37 [20.9] vs -28 mm [21.7], P =.02), a difference that remained significant up to 3 hours. Serious adverse events (24% vs 19%) and 30-day mortality (3 vs 2) were similar between clevedipine and SOC, respectively, and there were no deaths during study drug administration.Conclusions In hypertensive AHF, clevidipine safely and rapidly reduces BP and improves dyspnea more effectively than SOC